Healthcare Provider Details

I. General information

NPI: 1770721466
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: 02/03/2009
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 CENTRE POINTE BLVD
TALLAHASSEE FL
32308-4893
US

IV. Provider business mailing address

PO BOX 19633
JACKSONVILLE FL
32245-9633
US

V. Phone/Fax

Practice location:
  • Phone: 850-878-2273
  • Fax: 850-671-5900
Mailing address:
  • Phone: 904-346-3338
  • Fax: 904-346-0815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number StateFL

VIII. Authorized Official

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