Provider Demographics
NPI:1316127277
Name:MID FLORIDA RADIATION ONCOLOGY ASSO
Entity type:Organization
Organization Name:MID FLORIDA RADIATION ONCOLOGY ASSO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:HARLAN
Authorized Official - Last Name:WOODY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD,
Authorized Official - Phone:772-468-3222
Mailing Address - Street 1:4400 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-7620
Mailing Address - Country:US
Mailing Address - Phone:281-337-3423
Mailing Address - Fax:281-337-2611
Practice Address - Street 1:1231 N LAWNWOOD CIR
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4707
Practice Address - Country:US
Practice Address - Phone:772-464-8121
Practice Address - Fax:772-460-5503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40568Medicare PIN