MEDICARE: CANCER SPECIALISTS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician
2	207RH0003X	Hematology & Oncology Physician

General Provider Information

NPI Number	:	1437844636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANCER SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	7015 A C SKINNER PKWY STE 1
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6932
Country	:	US
Telephone Number	:	904-363-2113
Fax Number	:	904-363-2606

Provider Business Practice Location Address
First Line	:	300 SAINT ELIZABETH WAY STE 230
Second Line	:
City	:	ST JOHNS
State	:	FL
Zip	:	32259-1153
Country	:	US
Telephone Number	:	904-823-3800
Fax Number	:	904-823-3801

Authorized Official
Title or Position	:	CEO
Name	:	ROBERT J PHELAN
Credential	:
Telephone Number	:	904-363-2113

Provider Enumeration Date	:	04/05/2023
Last Update Date	:	06/06/2023

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Directions to “CANCER SPECIALISTS, LLC ” Practice Location

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