Provider Demographics
NPI:1457300014
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:DR
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 86-4676
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-4676
Mailing Address - Country:US
Mailing Address - Phone:407-872-7786
Mailing Address - Fax:407-872-3630
Practice Address - Street 1:224 MEMORIAL MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5122
Practice Address - Country:US
Practice Address - Phone:386-231-4000
Practice Address - Fax:386-231-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
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
FL24852Medicare PIN