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General NPI Number Information
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NPI Number | 1003282492
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Entity Type | Organization
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Legal Business Name | FLORIDA CANCER SPECIALISTS & RESEARCH INSTITUTE, LLC
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 1400 N US HIGHWAY 441 SUITE 540
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City | LADY LAKE
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State | FL
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Zip | 32159-8987
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Country | US
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Telephone | 352-561-3290
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Fax | 352-561-3291
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Provider Business Mailing Address
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Address Line | PO BOX 102222
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City | ATLANTA
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State | GA
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Zip | 30368-2222
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Country | US
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Telephone | 239-274-8200
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Fax | 239-278-3350
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Authorized Official
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Title or Position | PRESIDENT
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Name | LUCIO NAVARRO GORDAN
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Credential |
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Telephone | 239-274-8200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RH0000X
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Taxonomy Name | Hematology (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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