FLORIDA CANCER SPECIALISTS & RESEARCH INSTITUTE, LLC

Provider Demographics

• NPI: 1760590962
• Name: FLORIDA CANCER SPECIALISTS & RESEARCH INSTITUTE, LLC
• Entity Type: Organization
• Organization Name: FLORIDA CANCER SPECIALISTS & RESEARCH INSTITUTE, LLC
• Other - Org Name: FLORIDA CANCER SPECIALISTS P L
• Other - Org Type: Former Legal Business Name
• Authorized Official - Title/Position: PRESIDENT/MANAGING PARTNER
• Authorized Official - Prefix: DR
• Authorized Official - First Name: LUCIO
• Authorized Official - Middle Name: N
• Authorized Official - Last Name: GORDAN
• Authorized Official - Credentials: MD
• Authorized Official - Phone: 352-332-3900
• Mailing Address - Street 1: 4371 VERONICA S SHOEMAKER BLVD
• Mailing Address - Street 2: ATTN: CREDENTIAL DEPT
• 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: 1708 CAPE CORAL PKWY W
• Practice Address - Street 2: #10
• Practice Address - City: CAPE CORAL
• Practice Address - State: FL
• Practice Address - Zip Code: 33914-6985
• Practice Address - Country: US
• Practice Address - Phone: 239-541-4633
• Practice Address - Fax: 239-541-1825
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-08-28
• Last Update Date: 2022-04-27

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207RH0003X	Allopathic & Osteopathic Physicians	Internal Medicine	Hematology & Oncology	Group - Multi-Specialty
No	207RH0000X	Allopathic & Osteopathic Physicians	Internal Medicine	Hematology	Group - Multi-Specialty
Yes	207RX0202X	Allopathic & Osteopathic Physicians	Internal Medicine	Medical Oncology	Group - Multi-Specialty
No	207ZC0006X	Allopathic & Osteopathic Physicians	Pathology	Clinical Pathology	Group - Multi-Specialty
No	207ZH0000X	Allopathic & Osteopathic Physicians	Pathology	Hematology	Group - Multi-Specialty
No	207ZP0102X	Allopathic & Osteopathic Physicians	Pathology	Anatomic Pathology & Clinical Pathology	Group - Multi-Specialty
No	2085R0001X	Allopathic & Osteopathic Physicians	Radiology	Radiation Oncology	Group - Multi-Specialty
No	2085R0202X	Allopathic & Osteopathic Physicians	Radiology	Diagnostic Radiology	Group - Multi-Specialty
No	2085R0203X	Allopathic & Osteopathic Physicians	Radiology	Therapeutic Radiology	Group - Multi-Specialty
No	291U00000X	Laboratories	Clinical Medical Laboratory		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
FL	2540169-38	Medicaid
FL	2540169-39	Medicaid
FL	2540169-41	Medicaid
FL	254016900	Medicaid
FL	254016902	Medicaid
FL	254016915	Medicaid
FL	254016917	Medicaid
FL	254016919	Medicaid
FL	2540169-35	Medicaid
FL	254016904	Medicaid
FL	254016918	Medicaid
FL	254016922	Medicaid
FL	254016931	Medicaid
FL	254016934	Medicaid
FL	254016909	Medicaid
FL	254016910	Medicaid
FL	254016912	Medicaid
FL	254016916	Medicaid
FL	2540169-42	Medicaid
FL	2540169-43	Medicaid
FL	254016930	Medicaid
FL	254016932	Medicaid
FL	2540169-40	Medicaid
FL	254016901	Medicaid
FL	254016908	Medicaid
FL	254016924	Medicaid
FL	2540169-37	Medicaid
FL	254016906	Medicaid
FL	254016920	Medicaid
FL	254016928	Medicaid
FL	254016933	Medicaid
FL	254016911	Medicaid
FL	254016913	Medicaid
FL	254016903	Medicaid
FL	254016925	Medicaid
FL	254016927	Medicaid
FL	254016929	Medicaid
FL	254016910	Medicaid
FL	CN6270	Medicare PIN
FL	254016929	Medicaid
FL	254016925	Medicaid
FL	254016915	Medicaid
FL	2540169-37	Medicaid
FL	254016908	Medicaid
FL	254016913	Medicaid
FL	1310760013	Medicare NSC
FL	1310760008	Medicare NSC
FL	254016903	Medicaid
	21682	Medicare PIN
FL	21682E	Medicare PIN