Provider Demographics
NPI:1235327362
Name:FLORIDA ONCOLOGY NETWORK PA
Entity Type:Organization
Organization Name:FLORIDA ONCOLOGY NETWORK PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SOLLACCIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-872-7786
Mailing Address - Street 1:PO BOX 1031
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32802-1031
Mailing Address - Country:US
Mailing Address - Phone:407-872-7786
Mailing Address - Fax:407-872-3630
Practice Address - Street 1:680 PEACHWOOD DR
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-0902
Practice Address - Country:US
Practice Address - Phone:386-822-5502
Practice Address - Fax:386-738-6824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME563712085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24852EMedicare PIN