Provider Demographics
NPI:1770721466
Name:PHYSICIANS FOR A COMMUNITY UNITED FOR RESEARCH AND EDUCATION LLC
Entity type:Organization
Organization Name:PHYSICIANS FOR A COMMUNITY UNITED FOR RESEARCH AND EDUCATION LLC
Other - Org Name:
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:PO BOX 19633
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-9633
Mailing Address - Country:US
Mailing Address - Phone:904-346-3338
Mailing Address - Fax:904-346-0815
Practice Address - Street 1:2003 CENTRE POINTE BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4893
Practice Address - Country:US
Practice Address - Phone:850-878-2273
Practice Address - Fax:850-671-5900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207RX0202X, 2085R0001X, 2085R0202X, 207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL33021OtherBCBSFL
FLBD662AMedicare PIN