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General NPI Number Information
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NPI Number | 1770739104
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Entity Type | Organization
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Legal Business Name | PHYSICIANS FOR A COMMUNITY UNITED FOR RESEARCH AND EDUCATION LLC
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 07/14/2009
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Provider Practice Location Address
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Address Line | 795 SW STATE ROAD 47
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City | LAKE CITY
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State | FL
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Zip | 32025-0453
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Country | US
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Telephone | 386-758-7822
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Fax | 386-758-2224
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Provider Business Mailing Address
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Address Line | 3599 UNIVERSITY BLVD S STE 1000
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4280
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Country | US
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Telephone | 904-346-3338
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Fax | 904-346-0815
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHYAM B PARYANI
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Credential | M.D.
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Telephone | 904-346-3338
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207U00000X
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Taxonomy Name | Nuclear Medicine 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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State |
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