Healthcare Provider Details

I. General information

NPI: 1023306107
Provider Name (Legal Business Name): FLORIDA CANCER SPECIALISTS P L
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N US HIGHWAY 441 SUITE 552
LADY LAKE FL
32159-8987
US

IV. Provider business mailing address

4371 VERONICA S SHOEMAKER BLVD ATTN: CREDENTIALING DEPARTMENT
FORT MYERS FL
33916-2216
US

V. Phone/Fax

Practice location:
  • Phone: 352-753-9777
  • Fax: 352-753-9781
Mailing address:
  • Phone: 239-274-8200
  • Fax: 239-278-3350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM N HARWIN
Title or Position: PRESIDENT/PARTNER
Credential: M.D.
Phone: 239-274-8200