Healthcare Provider Details

I. General information

NPI: 1801148473
Provider Name (Legal Business Name): CANCER SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2012
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5742 BOOTH RD SUITE A
JACKSONVILLE FL
32207-5982
US

IV. Provider business mailing address

7015 AC SKINNER PARKWAY SUITE 1
JACKSONVILLE FL
32256
US

V. Phone/Fax

Practice location:
  • Phone: 904-739-7779
  • Fax: 904-739-7771
Mailing address:
  • Phone: 904-363-2113
  • Fax: 904-538-3672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. ROBERT J PHELAN
Title or Position: CREDENTIALING
Credential:
Phone: 904-363-2113