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General NPI Number Information
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NPI Number | 1306833595
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Entity Type | Organization
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Legal Business Name | H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC
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Dates
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Enumeration Date | 10/03/2005
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Last Update Date | 12/26/2024
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Provider Practice Location Address
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Address Line | 12902 USF MAGNOLIA DR
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City | TAMPA
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State | FL
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Zip | 33612-9416
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Country | US
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Telephone | 813-745-4673
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 198441
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City | ATLANTA
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State | GA
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Zip | 30384-8441
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Country | US
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Telephone | 866-761-5658
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MAUREEN CLEMENT
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Credential |
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Telephone | 813-745-4673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology 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 | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) 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 | 2083P0901X
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Taxonomy Name | Public Health & General Preventive 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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #5
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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 #6
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number |
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License Number State |
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Taxonomy #7
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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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