Provider Demographics
NPI:1790074342
Name:FLORIDA INSTITUTE OF RESEARCH, MEDICINE, AND SURGERY, P.A.
Entity Type:Organization
Organization Name:FLORIDA INSTITUTE OF RESEARCH, MEDICINE, AND SURGERY, P.A.
Other - Org Name:CANCER CENTERS OF FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALS/MNGD CARE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:B
Authorized Official - Last Name:CECIL
Authorized Official - Suffix:
Authorized Official - Credentials:CPCS
Authorized Official - Phone:407-426-8484
Mailing Address - Street 1:70 W. GORE STREET, SUITE 100
Mailing Address - Street 2:CREDENTIALING DEPARTMENT
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1124
Mailing Address - Country:US
Mailing Address - Phone:407-426-8484
Mailing Address - Fax:407-447-5229
Practice Address - Street 1:1561 W. FAIRBANKS AVENUE
Practice Address - Street 2:SUITE 300
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4678
Practice Address - Country:US
Practice Address - Phone:407-478-4200
Practice Address - Fax:407-339-8670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL601044207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260147802Medicaid