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General NPI Number Information
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NPI Number | 1215101902
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Entity Type | Organization
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Legal Business Name | 21ST CENTURY ONCOLOGY OF JACKSONVILLE LLC
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 01/05/2011
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Provider Practice Location Address
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Address Line | 1235 SAN MARCO BLVD SUITE 3
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8554
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Country | US
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Telephone | 904-493-5100
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Fax | 904-493-5130
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Provider Business Mailing Address
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Address Line | 2234 COLONIAL BLVD
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City | FORT MYERS
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State | FL
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Zip | 33907-1412
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Country | US
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Telephone | 239-931-7342
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Fax | 239-931-7385
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DANIEL E. DOSORETZ
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Credential | MD
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Telephone | 239-931-7275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical 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 | 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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