Organization
H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC
Active
Other names
MOFFITT MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
MAUREEN CLEMENT (DIRECTOR)
(813) 745-4673
Entity
Organization
Contact information
Practice address
12902 USF MAGNOLIA DR, TAMPA, FL 33612-9416
(813) 745-4673
Mailing address
PO BOX 198441, ATLANTA, GA 30384-8441
(866) 761-5658
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207RH0003X
Hematology & Oncology Physician
Primary
—
—
207SG0201X
Clinical Genetics (M.D.) Physician
—
—
207VX0201X
Gynecologic Oncology Physician
—
—
2083P0901X
Public Health & General Preventive Medicine Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
2086X0206X
Surgical Oncology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10D0965510
CLIA
FL
01
—
24755
BCBS
FL
01
—
3400057
UNITED HEALTHCARE
FL
05
—
373056500
—
FL
Enumeration date
10/03/2005
Last updated
12/26/2024
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