Provider Demographics
NPI:1750615183
Name:PHYSICIANS FOR A COMMUNITY UNITED FOR RESEARCH AND ECUDATION LLC
Entity type:Organization
Organization Name:PHYSICIANS FOR A COMMUNITY UNITED FOR RESEARCH AND ECUDATION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHYAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:PARYANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-346-3338
Mailing Address - Street 1:3599 UNIVERSITY BLVD S
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4252
Mailing Address - Country:US
Mailing Address - Phone:904-346-3338
Mailing Address - Fax:904-346-0815
Practice Address - Street 1:425 S PARSONS AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5289
Practice Address - Country:US
Practice Address - Phone:813-571-6464
Practice Address - Fax:813-571-6465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty