Provider Demographics
NPI:1316198435
Name:FLORIDA CANCER SPECIALISTS P L
Entity Type:Organization
Organization Name:FLORIDA CANCER SPECIALISTS P L
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:N
Authorized Official - Last Name:HARWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-274-8200
Mailing Address - Street 1:4371 VERONICA S SHOEMAKER BLVD
Mailing Address - Street 2:ATTN: CREDENTIAL DEPARTMENT
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-2216
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:239-278-3350
Practice Address - Street 1:1609 PASADENA AVE S
Practice Address - Street 2:STE. 2E
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-4565
Practice Address - Country:US
Practice Address - Phone:727-344-6569
Practice Address - Fax:727-384-4388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254016921Medicaid
FL1310760019Medicare NSC
21682EMedicare PIN