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General NPI Number Information
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NPI Number | 1861689424
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Entity Type | Organization
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Legal Business Name | PALM COAST ONCOLOGY
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Dates
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Enumeration Date | 09/27/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 61 MEMORIAL MEDICAL PKWY SUITE 3808
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City | PALM COAST
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State | FL
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Zip | 32164-5981
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Country | US
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Telephone | 386-586-2889
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Fax | 386-586-2890
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Provider Business Mailing Address
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Address Line | 61 MEMORIAL MEDICAL PKWY SUITE 3808
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City | PALM COAST
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State | FL
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Zip | 32164-5981
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Country | US
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Telephone | 386-586-2889
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Fax | 386-586-2890
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Authorized Official
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Title or Position | PRESIDENT OF CORPORATION
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Name | PHILIP NDEP NDUM
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Credential | M.D
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Telephone | 386-586-2889
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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 | ME88511
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License Number State | FL
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