Provider Demographics
NPI:1972924918
Name:BOCA RADIATION ONCOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:BOCA RADIATION ONCOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-368-4998
Mailing Address - Street 1:1599 NW 9TH AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1314
Mailing Address - Country:US
Mailing Address - Phone:561-368-4997
Mailing Address - Fax:561-584-7775
Practice Address - Street 1:6274 LINTON BLVD
Practice Address - Street 2:STE 100
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6508
Practice Address - Country:US
Practice Address - Phone:561-368-4998
Practice Address - Fax:561-584-7775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-18
Last Update Date:2017-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013038900Medicaid
FLHW372AMedicare PIN