Healthcare Provider Details

I. General information

NPI: 1316127277
Provider Name (Legal Business Name): MID FLORIDA RADIATION ONCOLOGY ASSO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 N LAWNWOOD CIR
FORT PIERCE FL
34950-4707
US

IV. Provider business mailing address

4400 COUNTRY CLUB DR
DICKINSON TX
77539-7620
US

V. Phone/Fax

Practice location:
  • Phone: 772-464-8121
  • Fax: 772-460-5503
Mailing address:
  • Phone: 281-337-3423
  • Fax: 281-337-2611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RONALD HARLAN WOODY III
Title or Position: PRESIDENT
Credential: M.D.,
Phone: 772-468-3222