Healthcare Provider Details

I. General information

NPI: 1275876187
Provider Name (Legal Business Name): FLORIDA CANCER SPECIALISTS & RESEARCH INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 02/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E DIXIE AVE SUITE 1001
LEESBURG FL
34748-5953
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: 352-787-9448
  • Fax: 352-787-3250
Mailing address:
  • Phone: 239-274-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LUCIO NAVARRO GORDAN
Title or Position: PRESIDENT
Credential:
Phone: 239-274-8200