Healthcare Provider Details

I. General information

NPI: 1770739104
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: 08/18/2008
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 SW STATE ROAD 47
LAKE CITY FL
32025-0453
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 386-758-7822
  • Fax: 386-758-2224
Mailing address:
  • Phone: 904-346-3338
  • Fax: 904-346-0815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHYAM B PARYANI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 904-346-3338