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General NPI Number Information
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NPI Number | 1124300983
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Entity Type | Organization
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Legal Business Name | CENTRAL FLORIDA CANCER & BLOOD CENTER PA
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Dates
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Enumeration Date | 09/16/2011
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Last Update Date | 10/19/2018
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Provider Practice Location Address
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Address Line | 2494 SW 19TH AVENUE RD
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City | OCALA
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State | FL
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Zip | 34471-7859
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Country | US
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Telephone | 352-671-4422
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Fax | 352-671-4423
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Provider Business Mailing Address
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Address Line | PO BOX 1988
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City | OCALA
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State | FL
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Zip | 34478-1988
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RAVI KOTI
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Credential | M.D.
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Telephone | 352-671-4422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | ME93537
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License Number State | FL
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