MEDICARE: CANCER CARE OF NORTH FLORIDA 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	207RX0202X	Medical Oncology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DE8930	OTHER	FL	RR MCR
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	39239	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1790728947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANCER CARE OF NORTH FLORIDA PA

Provider Business Mailing Address
First Line	:	PO BOX 1642
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32056-1642
Country	:	US
Telephone Number	:	386-755-1655
Fax Number	:	386-755-2330

Provider Business Practice Location Address
First Line	:	289 SW STONEGATE TER
Second Line	:	SUITE 103
City	:	LAKE CITY
State	:	FL
Zip	:	32024-3457
Country	:	US
Telephone Number	:	386-755-1655
Fax Number	:	386-755-2330

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WASEEM KHAN
Credential	:	M.D.
Telephone Number	:	386-755-1655

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	12/30/2024

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Practice Location Address:

289 SW STONEGATE TERR , SUITE #103
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1750358073 — MS. SHELIA Y ROBERTS ARNP
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1073557864 — WASEEMULLAH KHAN MD
Practice Location Address:

289 SW STONEGATE TER , SUITE103
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32024-3457

Practice Phone: 386-755-1655
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1467607903 — MRS. SARA DAUGHTRY MCCLAIN P.T.A.
Practice Location Address:

289 SW STONEGATE TER , SUITE 101
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1811376601 — MRS. JESSICA LYNN DOUGLAS FNP-BC
Practice Location Address:

289 SW STONEGATE TER STE 103
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1073040382 — DR. JOHN J BERGIN MD
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Directions to “CANCER CARE OF NORTH FLORIDA PA ” Practice Location

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