Healthcare Provider Details

I. General information

NPI: 1053600510
Provider Name (Legal Business Name): FLORIDA INSTITUTE OF RESEARCH, MEDICINE, AND SURGERY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 W. GORE STREET SUITE 100
ORLANDO FL
32806-1124
US

IV. Provider business mailing address

70 W. GORE STREET, SUITE 100 CREDENTIALING DEPARTMENT
ORLANDO FL
32806-1124
US

V. Phone/Fax

Practice location:
  • Phone: 407-426-8484
  • Fax: 407-447-5229
Mailing address:
  • Phone: 407-426-8484
  • Fax: 407-447-5229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number601042
License Number StateFL

VIII. Authorized Official

Name: LEE B CECIL
Title or Position: CREDENTIALS/MNGD CARE COORDINATOR
Credential: CPCS
Phone: 407-426-8484