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General NPI Number Information
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NPI Number | 1629461371
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Entity Type | Organization
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Legal Business Name | FLORIDA ONCOLOGY TAVARES, LLC
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Dates
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Enumeration Date | 03/05/2015
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Last Update Date | 10/29/2015
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Provider Practice Location Address
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Address Line | 2010 NIGHTINGALE LN
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City | TAVARES
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State | FL
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Zip | 32778-4361
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Country | US
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Telephone | 352-742-3045
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Fax |
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Provider Business Mailing Address
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Address Line | 2010 NIGHTINGALE LANE
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City | TAVARES
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State | FL
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Zip | 32778-4361
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MGRM
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Name | DR. DAVID DIAMOND
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Credential | M.D.
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Telephone | 352-742-3045
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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 | ME78350
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License Number State | FL
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