Provider Demographics
NPI:1790484152
Name:FLORIDA CANCER SPECIALISTS & RESEARCH INSTITUTE, LLC
Entity Type:Organization
Organization Name:FLORIDA CANCER SPECIALISTS & RESEARCH INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT /MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LUCIO
Authorized Official - Middle Name:NAVARRO
Authorized Official - Last Name:GORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-332-3900
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:2200 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1674
Practice Address - Country:US
Practice Address - Phone:407-321-3040
Practice Address - Fax:407-321-3041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-24
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Multi-Specialty