Healthcare Provider Details

I. General information

NPI: 1134433006
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: 08/03/2010
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 SW 33RD RD
OCALA FL
34474-7459
US

IV. Provider business mailing address

3599 UNIVERSITY BLVD S SUITE 1000
JACKSONVILLE FL
32216-4252
US

V. Phone/Fax

Practice location:
  • Phone: 352-291-2495
  • Fax: 352-219-2498
Mailing address:
  • Phone: 904-346-3338
  • Fax: 904-346-0815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHYAM B PARYANI
Title or Position: PRESIDENT
Credential: MD
Phone: 904-346-3338