Healthcare Provider Details

I. General information

NPI: 1881770659
Provider Name (Legal Business Name): VAN G RANA 09221980
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 BROADWAY
FORT MYERS FL
33901-8108
US

IV. Provider business mailing address

4371 VERONICA S SHOEMAKER BLVD ATTN: CREDENTIAL DEPARTMENT
FORT MYERS FL
33916-2216
US

V. Phone/Fax

Practice location:
  • Phone: 239-275-6400
  • Fax: 239-275-0178
Mailing address:
  • Phone: 239-274-8200
  • Fax: 239-278-3350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME37410
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: