Healthcare Provider Details

I. General information

NPI: 1285784389
Provider Name (Legal Business Name): MID-FLORIDA RADIATION ONCOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1780 SE HILLMOOR DR
PORT ST LUCIE FL
34952-7558
US

IV. Provider business mailing address

4400 COUNTRY CLUB DR
DICKINSON TX
77539-7620
US

V. Phone/Fax

Practice location:
  • Phone: 772-335-2115
  • Fax: 772-335-4480
Mailing address:
  • Phone: 281-337-3423
  • Fax: 281-337-2611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RONALD HARLEN WOODY III
Title or Position: PRESIDENT
Credential: M.D.,
Phone: 772-468-3222