Healthcare Provider Details

I. General information

NPI: 1255312591
Provider Name (Legal Business Name): SERVILLANO DELA CRUZ JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2231 HIGHWAY 44 W
INVERNESS FL
34453-3879
US

IV. Provider business mailing address

3498 N GRAYHAWK LOOP
LECANTO FL
34461-8466
US

V. Phone/Fax

Practice location:
  • Phone: 352-860-7400
  • Fax: 352-860-7450
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME81376
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: