Organization
INTER COMMUNITY CANCER INSTITUTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HAL M JACOBSON MD (MEDICAL DIRECTOR)
(352) 243-9709
Entity
Organization
Contact information
Practice address
1920 DON WICKHAM DR, SUITE 130, CLERMONT, FL 34711-1918
(352) 243-9709
(352) 243-8703
Mailing address
1920 DON WICKHAM DR STE 130, CLERMONT, FL 34711-1978
(352) 243-9709
(352) 243-8703
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274517800
—
FL
01
—
72079
HEALTH OPTIONS
FL
01
—
DN5766
RR MEDICARE
FL
Enumeration date
07/01/2006
Last updated
04/29/2015
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