Provider Demographics
NPI:1063655041
Name:ANITA D SPITZ M D P A
Entity Type:Organization
Organization Name:ANITA D SPITZ M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:GEARIN
Authorized Official - Last Name:SEAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-383-0112
Mailing Address - Street 1:500 NORTH WASHINGTON AVE.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2759
Mailing Address - Country:US
Mailing Address - Phone:321-383-0112
Mailing Address - Fax:321-383-0229
Practice Address - Street 1:500 NORTH WASHINGTON AVE.
Practice Address - Street 2:SUITE 103
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2759
Practice Address - Country:US
Practice Address - Phone:321-383-0112
Practice Address - Fax:321-383-0229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58817207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE75473Medicare UPIN