Provider Demographics
NPI:1033451950
Name:SPENCE, KENRICK ANTHONY I (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:KENRICK
Middle Name:ANTHONY
Last Name:SPENCE
Suffix:I
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 HILLCREST ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-1210
Mailing Address - Country:US
Mailing Address - Phone:407-999-2585
Mailing Address - Fax:407-999-2628
Practice Address - Street 1:130 HILLCREST ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-1210
Practice Address - Country:US
Practice Address - Phone:407-999-2585
Practice Address - Fax:407-999-2628
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77827208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery