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General NPI Number Information
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NPI Number | 1528275781
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Entity Type | Organization
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Legal Business Name | EAST LAKE ONCOLOGY
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 01/28/2008
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Provider Practice Location Address
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Address Line | 4114 WOODLANDS PKWY SUITE 301
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City | PALM HARBOR
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State | FL
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Zip | 34685-3450
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Country | US
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Telephone | 727-789-2595
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Fax | 727-789-8891
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Provider Business Mailing Address
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Address Line | 4114 WOODLANDS PKWY SUITE 301
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City | PALM HARBOR
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State | FL
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Zip | 34685-3450
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Country | US
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Telephone | 727-789-2595
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Fax | 727-789-8891
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Authorized Official
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Title or Position | PRESIDENT
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Name | D. ANDA NORBERGS
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Credential | M.D.
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Telephone | 727-789-2595
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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 | ME0056118
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License Number State | FL
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