Provider Demographics
NPI:1144211988
Name:MID FLORIDA RADIATION ONCOLOGY ASSO
Entity Type:Organization
Organization Name:MID FLORIDA RADIATION ONCOLOGY ASSO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:HARLAN
Authorized Official - Last Name:WOODY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD,
Authorized Official - Phone:772-468-3222
Mailing Address - Street 1:4400 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-7620
Mailing Address - Country:US
Mailing Address - Phone:281-337-3423
Mailing Address - Fax:281-337-2611
Practice Address - Street 1:604 W MIDWAY RD
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-4201
Practice Address - Country:US
Practice Address - Phone:772-468-3222
Practice Address - Fax:772-460-7927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40568Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER