Provider Demographics
| NPI: | 1760590962 |
|---|---|
| Name: | FLORIDA CANCER SPECIALISTS & RESEARCH INSTITUTE, LLC |
| Entity type: | Organization |
| Organization Name: | FLORIDA CANCER SPECIALISTS & RESEARCH INSTITUTE, LLC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRESIDENT/MANAGING PARTNER |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | LUCIO |
| Authorized Official - Middle Name: | N |
| Authorized Official - Last Name: | GORDAN |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MD |
| Authorized Official - Phone: | 352-332-3900 |
| Mailing Address - Street 1: | PO BOX 102222 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | ATLANTA |
| Mailing Address - State: | GA |
| Mailing Address - Zip Code: | 30368-2222 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 239-274-8200 |
| Mailing Address - Fax: | 239-278-3350 |
| Practice Address - Street 1: | 1708 CAPE CORAL PKWY W |
| Practice Address - Street 2: | #10 |
| Practice Address - City: | CAPE CORAL |
| Practice Address - State: | FL |
| Practice Address - Zip Code: | 33914-6985 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 239-541-4633 |
| Practice Address - Fax: | 239-541-1825 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-08-28 |
| Last Update Date: | 2024-11-12 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
| No | 2085R0203X | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology | Group - Multi-Specialty |
| No | 291U00000X | Laboratories | Clinical Medical Laboratory | Group - Multi-Specialty | |
| No | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | Group - Multi-Specialty |
| No | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | Group - Multi-Specialty |
| No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
| No | 207RH0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology | Group - Multi-Specialty |
| No | 207ZC0006X | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology | Group - Multi-Specialty |
| No | 207ZH0000X | Allopathic & Osteopathic Physicians | Pathology | Hematology | Group - Multi-Specialty |
| Yes | 207RX0202X | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| FL | 254016903 | Medicaid | |
| FL | 254016916 | Medicaid | |
| FL | 2540169-35 | Medicaid | |
| FL | 2540169-41 | Medicaid | |
| FL | 254016902 | Medicaid | |
| FL | 254016906 | Medicaid | |
| FL | 254016909 | Medicaid | |
| FL | 254016918 | Medicaid | |
| FL | 254016929 | Medicaid | |
| FL | 254016930 | Medicaid | |
| FL | 254016932 | Medicaid | |
| FL | 2540169-38 | Medicaid | |
| FL | 254016912 | Medicaid | |
| FL | 254016917 | Medicaid | |
| FL | 254016928 | Medicaid | |
| FL | 254016900 | Medicaid | |
| FL | 254016901 | Medicaid | |
| FL | 254016908 | Medicaid | |
| FL | 254016911 | Medicaid | |
| FL | 2540169-37 | Medicaid | |
| FL | 2540169-39 | Medicaid | |
| FL | 2540169-40 | Medicaid | |
| FL | 2540169-43 | Medicaid | |
| FL | 254016904 | Medicaid | |
| FL | 254016913 | Medicaid | |
| FL | 254016915 | Medicaid | |
| FL | 254016931 | Medicaid | |
| FL | 254016933 | Medicaid | |
| FL | 254016934 | Medicaid | |
| FL | 254016924 | Medicaid | |
| FL | 2540169-42 | Medicaid | |
| FL | 254016919 | Medicaid | |
| FL | 254016922 | Medicaid | |
| FL | 254016927 | Medicaid | |
| FL | 254016910 | Medicaid | |
| FL | 254016920 | Medicaid | |
| FL | 254016925 | Medicaid | |
| FL | 254016910 | Medicaid | |
| FL | CN6270 | Medicare PIN | |
| FL | 254016929 | Medicaid | |
| FL | 254016925 | Medicaid | |
| FL | 254016915 | Medicaid | |
| FL | 2540169-37 | Medicaid | |
| FL | 254016908 | Medicaid | |
| FL | 254016913 | Medicaid | |
| FL | 1310760013 | Medicare NSC | |
| FL | 1310760008 | Medicare NSC | |
| FL | 254016903 | Medicaid | |
| 21682 | Medicare PIN | ||
| FL | 21682E | Medicare PIN |
