Provider Demographics
NPI:1437157062
Name:HEMATOLOGY AND MEDICAL ONCOLOGY OF SOUTHERN PALM BEACH COUNTY INC
Entity Type:Organization
Organization Name:HEMATOLOGY AND MEDICAL ONCOLOGY OF SOUTHERN PALM BEACH COUNTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGILIO
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRITO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-742-0065
Mailing Address - Street 1:2623 S SEACREST BLVD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7501
Mailing Address - Country:US
Mailing Address - Phone:561-742-0065
Mailing Address - Fax:561-742-0105
Practice Address - Street 1:2623 S SEACREST BLVD
Practice Address - Street 2:SUITE 216
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7501
Practice Address - Country:US
Practice Address - Phone:561-742-0065
Practice Address - Fax:561-742-0105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0989Medicare ID - Type Unspecified