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Organization
MONDAY, JULY 02, 2018
Active
Organization
MONDAY, JULY 02, 2018
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUCIO NAVARRO GORDAN (OWNER/PRESIDENT)
(239) 274-8200
Entity
Organization
Contact information
Practice address
3920 CAPITAL MALL DR SW STE 100, OLYMPIA, WA 98502-8701
(360) 345-1382
(360) 345-1382
Mailing address
9160 FORUM CORPORATE PKWY STE 350, FORT MYERS, FL 33905-7808
(239) 785-3200
Taxonomy
Speciality
Code
Description
License number
State
207RH0000X
Hematology (Internal Medicine) Physician
—
NULL
207RH0000X
Hematology (Internal Medicine) Physician
—
—
207RH0003X
Hematology & Oncology Physician
Primary
—
NULL
207RH0003X
Hematology & Oncology Physician
Primary
—
—
207RX0202X
Medical Oncology Physician
—
NULL
207RX0202X
Medical Oncology Physician
—
—
Other
Enumeration date
09/27/2019
Last updated
09/27/2019
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