Organization
PALM BEACH CANCER INSTITUTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA SAN ROMAN (CREDENTIALING COORDINATOR)
(561) 366-4104
Entity
Organization
Contact information
Practice address
1309 N FLAGLER DR, WEST PALM BEACH, FL 33401-3406
(561) 366-4100
(561) 366-4189
Mailing address
PO BOX 863310, ORLANDO, FL 32886-3310
(561) 366-4100
(561) 366-4189
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
267990600
—
FL
05
—
267990601
—
FL
05
—
267990602
—
FL
05
—
267990603
—
FL
05
—
267990604
—
FL
Enumeration date
06/17/2006
Last updated
01/21/2010
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