Healthcare Provider Details

I. General information

NPI: 1487052171
Provider Name (Legal Business Name): OCALA ONCOLOGY CENTER PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 08/27/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STATE AVE
PANAMA CITY FL
32405-4587
US

IV. Provider business mailing address

2100 STATE AVE
PANAMA CITY FL
32405-4587
US

V. Phone/Fax

Practice location:
  • Phone: 850-763-0036
  • Fax: 850-763-0259
Mailing address:
  • Phone: 850-763-0036
  • Fax: 850-763-0259

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 Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW M. WEBER
Title or Position: PHARMACY DIRECTOR
Credential: M.D.
Phone: 850-763-0036