MEDICARE: FLORIDA CANCER SPECIALISTS & RESEARCH INSTITUTE, LLC

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number State
1	207RH0000X	Hematology (Internal Medicine) Physician
2	2085R0202X	Diagnostic Radiology Physician
3	2085R0203X	Therapeutic Radiology Physician
4	207RX0202X	Medical Oncology Physician	FL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CN6270	OTHER	FL	RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1508973231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA CANCER SPECIALISTS & RESEARCH INSTITUTE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 102222
Second Line	:	ATTN: CREDENTIAL DEPARTMENT
City	:	ATLANTA
State	:	GA
Zip	:	30368-2222
Country	:	US
Telephone Number	:	239-274-8200
Fax Number	:	239-278-3350

Provider Business Practice Location Address
First Line	:	3630 MANATEE AVE W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34205-2557
Country	:	US
Telephone Number	:	941-792-1881
Fax Number	:	941-795-3924

Authorized Official
Title or Position	:	PRESIDENT/MANAGING PARTNER
Name	:	DR. LUCIO NAVARRO GORDAN
Credential	:
Telephone Number	:	239-274-8200

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	05/25/2022

3630 MANATEE AVE W , STE B
BRADENTON, FL
34205-2557

Practice Phone: 941-792-1881
Practice Fax: 941-795-3924