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General NPI Number Information
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NPI Number | 1548460546
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Entity Type | Organization
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Legal Business Name | RADIATION ONCOLOGY OF WEST FLORIDA
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 07/19/2007
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Provider Practice Location Address
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Address Line | 1201 5TH AVE NORTH SUITE 130
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City | ST PETERSBURG
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State | FL
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Zip | 33705
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Country | US
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Telephone | 727-825-1253
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Fax | 727-825-1332
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Provider Business Mailing Address
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Address Line | 117 WEST ALEXANDER ST PMB 387
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City | PLANT CITY
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State | FL
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Zip | 33563
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Country | US
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Telephone | 813-754-7756
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Fax | 813-754-7565
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Authorized Official
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Title or Position | PROVIDER
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Name | DR. CRAIG R MIERCORT
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Credential | M.D.
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Telephone | 813-754-7756
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | ME87496
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License Number State | FL
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