Provider Demographics
NPI:1851351985
Name:TAMPA BAY AREA CANCER CONSULTANTS PA
Entity Type:Organization
Organization Name:TAMPA BAY AREA CANCER CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:D
Authorized Official - Middle Name:ANDA
Authorized Official - Last Name:NORBERGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-789-2595
Mailing Address - Street 1:PO BOX 850001
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32885-0306
Mailing Address - Country:US
Mailing Address - Phone:727-789-2595
Mailing Address - Fax:727-789-8891
Practice Address - Street 1:4114 WOODLANDS PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-3494
Practice Address - Country:US
Practice Address - Phone:727-789-2595
Practice Address - Fax:727-450-1058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056118207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL09165OtherBCBSFL
FL1851351985OtherNPI GROUP
FLDA6603OtherRRW MEDICARE GRP
FLP00066801OtherRRW MEDICARE INDIVIDUAL
FL09165AOtherMEDICARE UNSPEC
FLDA6603OtherRRW MEDICARE GRP
FLP00066801OtherRRW MEDICARE INDIVIDUAL