Provider Demographics
NPI:1659641652
Name:ORLANDO PHYSICIAN SPECIALISTS LLC
Entity Type:Organization
Organization Name:ORLANDO PHYSICIAN SPECIALISTS LLC
Other - Org Name:SOUTHWEST CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHYAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:PARYANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-309-8680
Mailing Address - Street 1:PO BOX 19634
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-9634
Mailing Address - Country:US
Mailing Address - Phone:904-309-8680
Mailing Address - Fax:904-345-5841
Practice Address - Street 1:922 LUCERNE TER
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1013
Practice Address - Country:US
Practice Address - Phone:407-426-8660
Practice Address - Fax:407-426-6884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0027JOtherBCBS
FLFG093AMedicare PIN