| NPI | 1609278597 |
|---|---|
| Doing Business As | SAND LAKE CANCER CENTER DISPENSARY |
| Entity Type | Organization |
| Authorized Contact | ASHA JIAWAN Practice Administrator 407-351-1002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9106328) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME73340) |
| 174400000X Specialist (Licence: FL ME76724) | |
| 174400000X Specialist (Licence: FL ME116521) | |
| Enumeration Date | 2014-09-23 |
| Last Update Date | 2022-11-11 |