Healthcare Provider Details

I. General information

NPI: 1205152808
Provider Name (Legal Business Name): PHYSICIANS FOR A COMMUNITY UNITED FOR RESEARCH AND EDUCATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 W NEWBERRY RD
GAINESVILLE FL
32605-4308
US

IV. Provider business mailing address

3599 UNIVERSITY BLVD S STE 1000
JACKSONVILLE FL
32216-4280
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-5845
  • Fax: 352-333-5844
Mailing address:
  • Phone: 904-346-3338
  • Fax: 904-346-0815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHYAM B PARYANI
Title or Position: PRESIDENT
Credential: MD
Phone: 904-346-3338