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	207RH0003X	Hematology & Oncology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GM089A	OTHER	FL	MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1770257081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANCER SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	7751 BELFORT PKWY STE 350
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6951
Country	:	US
Telephone Number	:	904-363-2113
Fax Number	:	904-363-2606

Provider Business Practice Location Address
First Line	:	2563 OAK ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4559
Country	:	US
Telephone Number	:	904-388-2619
Fax Number	:	904-388-0240

Authorized Official
Title or Position	:	CEO
Name	:	ROBERT J PHELAN
Credential	:
Telephone Number	:	904-363-7442

Provider Enumeration Date	:	08/02/2021
Last Update Date	:	06/12/2025

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Directions to “CANCER SPECIALISTS, LLC ” Practice Location

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