H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC (NPI# 1306833595) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1306833595 |
Entity Type | Organization |
Organization Name | H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC |
Other Organization Name | MOFFITT MEDICAL GROUP |
Practice Address |
12902 Usf Magnolia Dr Tampa FL 33612-9416 |
Mailing Address |
Po Box 198441 Atlanta GA 30384-8441 |
Practice Telephone | 8137454673 |
Mailing Telephone | 8667615658 |
Enumeration Date | 2005-10-03 |
Last Update Date | 2015-02-02 |
Authorized Official Name | MARTHA BLANTON (CREDENTIALING COORDINATOR) |
Authorized Official Telephone | 8137454673 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians | ||
N | 207SG0201X |
Medical Genetics Specialization: Clinical Genetics (M.D.) |
Allopathic & Osteopathic Physicians | ||
N | 207VX0201X |
Obstetrics & Gynecology Specialization: Gynecologic Oncology |
Allopathic & Osteopathic Physicians | ||
N | 2083P0901X |
Preventive Medicine Specialization: Public Health & General Preventive Medicine |
Allopathic & Osteopathic Physicians | ||
N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians | ||
N | 2086X0206X |
Surgery Specialization: Surgical Oncology |
Allopathic & Osteopathic Physicians | ||
Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
FL | BCBS | 24755 | 01 |
FL | UNITED HEALTHCARE | 3400057 | 01 |
FL | CLIA | 10D0965510 | 01 |
FL | 373056500 | 05 |
Other Name | Type Code |
---|---|
MOFFITT MEDICAL GROUP | Doing Business As Name - Organization |
Street Address |
12902 USF MAGNOLIA DR |
City | TAMPA |
State | FL |
Zip Code | 33612-9416 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1669475158 | Jose Leonel Ochoa-bayona | Internal Medicine | 12902 Usf Magnolia Dr, Fob 3 Bmt, Tampa, FL 33612-9416 | 2005-05-27 |
1134735285 | Edith Abraham | Nurse Practitioner | 12902 Usf Magnolia Dr, Tampa, FL 33612-9416 | 2020-09-23 |
1134735442 | Lindsay Garcia | Dietitian, Registered | 12902 Usf Magnolia Dr, Tampa, FL 33612-9416 | 2020-09-22 |
1972117026 | Charsetta Denise Campbell | Nurse Practitioner | 12902 Usf Magnolia Dr, Tampa, FL 33612-9416 | 2020-09-06 |
1083228480 | Mary Thisbe Quilab | Nurse Practitioner | 12902 Usf Magnolia Dr, Tampa, FL 33612-9416 | 2020-09-02 |
1336758788 | Gabriella Anne Acosta | Nurse Practitioner | 12902 Usf Magnolia Dr, Tampa, FL 33612-9416 | 2020-07-30 |
1861010670 | Sidney Marie Resmondo | Nurse Practitioner | 12902 Usf Magnolia Dr, Tampa, FL 33612-9416 | 2020-07-08 |
1912523481 | Timothy Bondell | Nurse Practitioner | 12902 Usf Magnolia Dr, Tampa, FL 33612-9416 | 2020-06-22 |
1891319075 | Melanie Marie Fyfe | Clinical Nurse Specialist | 12902 Usf Magnolia Dr, Tampa, FL 33612-9416 | 2020-06-03 |
1780208876 | Jacqueline Nicole Arrison | Nurse Practitioner | 12902 Usf Magnolia Dr, Tampa, FL 33612-9416 | 2020-06-03 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1689286767 | Daniel Jimenez | Physical Therapist | 13000 Bruce B Downs Blvd, Tampa, Fl, Tampa, FL 33612 | 2020-08-19 |
1700426830 | Taz Stacy | Behavior Technician | 2701 University Square Drive, Tampa, FL 33612 | 2020-01-07 |
1841853215 | Eric Austen Keeler | Student in an Organized Health Care Education/Training Program | 12901 Bruce B Downs Blvd, Mdc5, Tampa, FL 33612 | 2019-04-20 |
1346700242 | Caitlyn Victoria Cartwright | Student in an Organized Health Care Education/Training Program | 12901 Bruce B. Downs Blvd., Mdc5, Tampa, FL 33612 | 2019-03-25 |
1720552953 | Marijo Bilitski | Student in an Organized Health Care Education/Training Program | 12901 Bruce B Downs Blvd # Blvd5, Tampa, FL 33612 | 2019-01-22 |
1790259190 | Belkis Aleman | Nurse Practitioner | 205 E Busch Blvd, Tampa, FL 33612 | 2019-01-18 |
1811469133 | Stephanie Stegner | Physician Assistant | 12901 Bruce B Downs Blvd Mdc 5, Tampa, FL 33612 | 2018-12-27 |
1053889857 | Alysia Heather Siegel | Psychologist | 1300 Bruce B. Downs Boulevard, 116b, Tampa, FL 33612 | 2018-11-09 |
1295202489 | Daisy Baby Pulinilkumkalayil | Nurse Practitioner | 1426 W. Bush Blvd. Suite #105, Suite #105, Tampa, FL 33612 | 2018-10-26 |
1649745258 | Rachel Rene Shelton | Specialist/Technologist | Orthopedics and Sports Medicine, 13330 Usf Laurel Drive, Tampa, FL 33612 | 2018-10-10 |
Find all providers in zip 33612 |
Taxonomy Code | 207RH0003X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Internal Medicine |
Specialization | Hematology & Oncology |
An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1194343210 | Jayaben Patel | Internal Medicine | 11818 Shire Wycliffe Ct, Tampa, FL 33626-3329 | 2020-07-07 |
1134464910 | Dae Won Kim | Internal Medicine | Moffitt Cancer Center 12902 Magnolia Drive, Tampa, FL 33612 | 2012-12-04 |
1366649881 | Tampa Bay Oncology-hematology Associates | Internal Medicine | 4910 N Armenia Ave, Tampa, FL 33603-1402 | 2007-06-28 |
1427068493 | Lewis E Auerbach | Internal Medicine | 2111 W. Swann Ave., Suite 102, Tampa, FL 33606-2478 | 2006-08-09 |
1750303905 | Tawee Tanvetyanon | Internal Medicine | H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33613 | 2006-07-24 |
1174571699 | Ron D Schiff | Internal Medicine | 3238 Cove Bend Dr, Tampa, FL 33613-2752 | 2006-05-05 |
1841273943 | Jawan Corine Ayer-cole | Internal Medicine | 800 W Dr Martin Luther King Jr Blvd, Ste4, Tampa, FL 33603-3320 | 2005-11-22 |
1669475158 | Jose Leonel Ochoa-bayona | Internal Medicine | 12902 Usf Magnolia Dr, Fob 3 Bmt, Tampa, FL 33612-9416 | 2005-05-27 |
1538691381 | Alexandre Mark Tungesvik | Internal Medicine | 17 Davis Blvd Ste 308, Tampa, FL 33606-3438 | 2017-03-31 |
1588110639 | Abdul Rashid Shah | Internal Medicine | 12902 Magnolia Drive, H.lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612 | 2016-08-29 |
Find all providers in TAMPA |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.