Provider Demographics
NPI:1659683050
Name:FLORIDA CANCER PHYSICIANS NETWORK LLC
Entity Type:Organization
Organization Name:FLORIDA CANCER PHYSICIANS NETWORK LLC
Other - Org Name:CHARLOTTE RADIATION ONCOLOGY 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:904-346-3338
Mailing Address - Street 1:3599 UNIVERSITY BLVD S
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4252
Mailing Address - Country:US
Mailing Address - Phone:904-346-3338
Mailing Address - Fax:904-346-0815
Practice Address - Street 1:3080 HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6720
Practice Address - Country:US
Practice Address - Phone:941-625-0111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty