Provider Demographics
NPI:1003879099
Name:RADIATION ONCOLOGY ASSOCIATES OF CENTRAL FLORIDA,PA
Entity Type:Organization
Organization Name:RADIATION ONCOLOGY ASSOCIATES OF CENTRAL FLORIDA,PA
Other - Org Name:RADIATION ONCOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:E
Authorized Official - Last Name:YAEGER
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:386-254-4220
Mailing Address - Street 1:PO BOX 1089
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32115-1089
Mailing Address - Country:US
Mailing Address - Phone:386-254-4220
Mailing Address - Fax:386-258-4995
Practice Address - Street 1:303 N CLYDE MORRIS BLVD
Practice Address - Street 2:ROC GROUND FLOOR
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2709
Practice Address - Country:US
Practice Address - Phone:386-254-4220
Practice Address - Fax:386-258-4995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99641OtherBLUE CROSS/BLUE SHIELD
FL99641OtherBLUE CROSS/BLUE SHIELD