=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558665638
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLORIDA CANCER SPECIALISTS & RESEARCH INSTITUTE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2011
-----------------------------------------------------
Last Update Date | 05/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 PINELLAS ST SUITE 300
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33756-3314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-447-8100
-----------------------------------------------------
Fax | 727-461-2603
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 102222
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30368-2222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-274-8200
-----------------------------------------------------
Fax | 239-278-3350
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/MANAGING PARTNER
-----------------------------------------------------
Name | DR. LUCIO NAVARRO GORDAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 239-274-8200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0000X
-----------------------------------------------------
Taxonomy Name | Hematology (Internal Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RX0202X
-----------------------------------------------------
Taxonomy Name | Medical Oncology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------