Provider Demographics
NPI:1073632139
Name:S. DAVID SPECTOR CARDIOVASCULAR SURGERY P A
Entity Type:Organization
Organization Name:S. DAVID SPECTOR CARDIOVASCULAR SURGERY P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:S
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SPECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-896-8585
Mailing Address - Street 1:PO BOV 751
Mailing Address - Street 2:
Mailing Address - City:GOTHA
Mailing Address - State:FL
Mailing Address - Zip Code:34734
Mailing Address - Country:US
Mailing Address - Phone:407-896-8585
Mailing Address - Fax:407-896-8546
Practice Address - Street 1:2501 N ORANGE AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4603
Practice Address - Country:US
Practice Address - Phone:407-896-8585
Practice Address - Fax:407-896-8546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME17472208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9258Medicare ID - Type UnspecifiedGROUP