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General NPI Number Information
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NPI Number | 1790728947
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Entity Type | Organization
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Legal Business Name | CANCER CARE OF NORTH FLORIDA PA
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 289 SW STONEGATE TER SUITE 103
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City | LAKE CITY
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State | FL
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Zip | 32024-3457
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Country | US
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Telephone | 386-755-1655
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Fax | 386-755-2330
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Provider Business Mailing Address
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Address Line | PO BOX 1642
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City | LAKE CITY
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State | FL
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Zip | 32056-1642
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Country | US
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Telephone | 386-755-1655
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Fax | 386-755-2330
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WASEEM KHAN
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Credential | M.D.
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Telephone | 386-755-1655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number |
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License Number State |
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