MEDICARE: FLORIDA ONCOLOGY NETWORK PA

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	ME56371	FL

General Provider Information

NPI Number	:	1457300014
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA ONCOLOGY NETWORK PA

Provider Business Mailing Address
First Line	:	PO BOX 86-4676
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32886-4676
Country	:	US
Telephone Number	:	407-872-7786
Fax Number	:	407-872-3630

Provider Business Practice Location Address
First Line	:	224 MEMORIAL MEDICAL PKWY
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-5122
Country	:	US
Telephone Number	:	386-231-4000
Fax Number	:	386-231-4001

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT JAMES SOLLACCIO
Credential	:	M.D.
Telephone Number	:	407-872-7786

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	08/09/2012

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