Provider Demographics
NPI:1205288594
Name:FLORIDA CANCER SPECIALISTS P L
Entity type:Organization
Organization Name:FLORIDA CANCER SPECIALISTS P L
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:N
Authorized Official - Last Name:HARWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-432-8500
Mailing Address - Street 1:4371 VERONICA S SHOEMAKER BLVD
Mailing Address - Street 2:ATTN CREDENTIALING
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-2216
Mailing Address - Country:US
Mailing Address - Phone:239-432-8500
Mailing Address - Fax:
Practice Address - Street 1:339 CYPRESS PKWY
Practice Address - Street 2:SUITE 180
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3329
Practice Address - Country:US
Practice Address - Phone:407-933-1877
Practice Address - Fax:407-933-1817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Multi-Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0149267-15Medicaid
FL0149267-15Medicaid