Provider Demographics
NPI:1063476430
Name:SPENCER, ANGELA S (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:S
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 N WICKHAM RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-8110
Mailing Address - Country:US
Mailing Address - Phone:321-752-7100
Mailing Address - Fax:321-752-7105
Practice Address - Street 1:2100 N WICKHAM RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935
Practice Address - Country:US
Practice Address - Phone:321-752-7100
Practice Address - Fax:321-752-7105
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00933022084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00382941OtherRR MEDICARE
FLNC002OtherFL HF MEDICARE
FL023440400Medicaid
FL16273OtherBCBS
FL272830300Medicaid