Healthcare Provider Details

I. General information

NPI: 1124544531
Provider Name (Legal Business Name): FLORIDA CANCER SPECIALISTS & RESEARCH INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4945 SW 49TH PL
OCALA FL
34474-9673
US

IV. Provider business mailing address

4371 VERONICA S SHOEMAKER BLVD
FORT MYERS FL
33916-2216
US

V. Phone/Fax

Practice location:
  • Phone: 352-237-9430
  • Fax: 352-237-9698
Mailing address:
  • Phone: 239-274-8200
  • Fax: 813-630-6120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

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