Provider Demographics
NPI:1164612289
Name:CARLOS E. SPERA MD PA
Entity Type:Organization
Organization Name:CARLOS E. SPERA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:E
Authorized Official - Last Name:SPERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-577-8585
Mailing Address - Street 1:12575 ORANGE DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-4302
Mailing Address - Country:US
Mailing Address - Phone:954-577-8585
Mailing Address - Fax:954-577-8556
Practice Address - Street 1:12575 ORANGE DR
Practice Address - Street 2:SUITE 303
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-4302
Practice Address - Country:US
Practice Address - Phone:954-577-8585
Practice Address - Fax:954-577-8556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1196261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAH342Medicare PIN