Healthcare Provider Details

I. General information

NPI: 1689925240
Provider Name (Legal Business Name): CANCER SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 SAN BARTOLA DR
ST AUGUSTINE FL
32086-5767
US

IV. Provider business mailing address

7751 BELFORT PKWY STE 350
JACKSONVILLE FL
32256-6951
US

V. Phone/Fax

Practice location:
  • Phone: 904-825-4500
  • Fax: 904-528-3672
Mailing address:
  • Phone: 904-363-2113
  • Fax: 904-538-3672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. ROBERT J PHELAN
Title or Position: CEO
Credential:
Phone: 904-363-2113