Organization
NORTH FLORIDA CANCER CENTER LAKE CITY LLC
Active
Other names
The Cancer Center at Lake City
Organization subpart
No
Provider details
NPI number
Authorized official
JOAN R GLADNEY (REGIONAL DIRECTOR)
(352) 474-6190
Entity
Organization
Contact information
Practice address
795 SW HIGHWAY 47, LAKE CITY, FL 32025
(386) 758-7822
(386) 758-2224
Mailing address
795 SW STATE ROAD 47, LAKE CITY, FL 32025-0453
(386) 758-7822
(386) 758-2224
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
272085000
—
FL
01
—
74629
BCBS
FL
01
—
DD1689
RR MEDICARE
FL
Enumeration date
10/04/2005
Last updated
05/01/2012
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