Provider Demographics
NPI:1225320971
Name:FLORIDA UROLOGY ONCOLOGY AND UROGYNECOLOGY LLC
Entity Type:Organization
Organization Name:FLORIDA UROLOGY ONCOLOGY AND UROGYNECOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIL
Authorized Official - Middle Name:U
Authorized Official - Last Name:REHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-435-8307
Mailing Address - Street 1:215 LITHIA PINECREST RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5307
Mailing Address - Country:US
Mailing Address - Phone:813-681-2300
Mailing Address - Fax:813-681-2300
Practice Address - Street 1:215 LITHIA PINECREST RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5307
Practice Address - Country:US
Practice Address - Phone:813-681-2300
Practice Address - Fax:813-681-2300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81146208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherEIN