Provider Demographics
NPI:1952604696
Name:FLORIDA CANCER SPECIALISTS & RESEARCH INSTITUTE, LLC
Entity Type:Organization
Organization Name:FLORIDA CANCER SPECIALISTS & RESEARCH INSTITUTE, LLC
Other - Org Name:FLORIDA CANCER SPECIALISTS P L
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCIO
Authorized Official - Middle Name:NAVARRO
Authorized Official - Last Name:GORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-274-8200
Mailing Address - Street 1:4371 VERONICA S SHOEMAKER BLVD
Mailing Address - Street 2:ATTN: CREDENTIAL DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-2216
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:239-278-3350
Practice Address - Street 1:3280 N MCMULLEN BOOTH RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2029
Practice Address - Country:US
Practice Address - Phone:727-216-1141
Practice Address - Fax:727-796-6159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207RH0000X, 207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Multi-Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2540169-37Medicaid
FL1310760034Medicare NSC
FL21682EMedicare PIN