Healthcare Provider Details

I. General information

NPI: 1528323268
Provider Name (Legal Business Name): CANCER SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7015 AC SKINNER PARKWAY SUITE 1
JACKSONVILLE FL
32256
US

IV. Provider business mailing address

7015 AC SKINNER PARKWAY SUITE 1
JACKSONVILLE FL
32256
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPH26314
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: ROBERT J PHELAN
Title or Position: CEO
Credential: RPH
Phone: 904-363-2113