Provider Demographics
NPI:1790054872
Name:FLORIDA CANCER AFFILIATES PL
Entity Type:Organization
Organization Name:FLORIDA CANCER AFFILIATES PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-484-7722
Mailing Address - Street 1:11373 CORTEZ BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5414
Mailing Address - Country:US
Mailing Address - Phone:352-597-4998
Mailing Address - Fax:352-596-6051
Practice Address - Street 1:11373 CORTEZ BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5414
Practice Address - Country:US
Practice Address - Phone:352-597-4998
Practice Address - Fax:352-596-6051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004381500Medicaid
FL265199800Medicaid
FLFS826AMedicare PIN
FL004381500Medicaid