Provider Demographics
NPI:1306857198
Name:BAY AREA ONCOLOGY
Entity Type:Organization
Organization Name:BAY AREA ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:813-875-2300
Mailing Address - Street 1:4301 N HABANA AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6546
Mailing Address - Country:US
Mailing Address - Phone:813-875-2300
Mailing Address - Fax:813-876-5661
Practice Address - Street 1:4301 N HABANA AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6546
Practice Address - Country:US
Practice Address - Phone:813-875-2300
Practice Address - Fax:813-876-5661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME30523207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC0583Medicare ID - Type UnspecifiedRAIL ROAD