Healthcare Provider Details

I. General information

NPI: 1790728947
Provider Name (Legal Business Name): CANCER CARE OF NORTH FLORIDA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 SW STONEGATE TER SUITE 103
LAKE CITY FL
32024-3457
US

IV. Provider business mailing address

PO BOX 1642
LAKE CITY FL
32056-1642
US

V. Phone/Fax

Practice location:
  • Phone: 386-755-1655
  • Fax: 386-755-2330
Mailing address:
  • Phone: 386-755-1655
  • Fax: 386-755-2330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WASEEM KHAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 386-755-1655