Provider Demographics
NPI:1275533705
Name:SPITZER, ROGER DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:DANIEL
Last Name:SPITZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4430 SHERIDAN ST STE A
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3546
Mailing Address - Country:US
Mailing Address - Phone:954-962-0040
Mailing Address - Fax:954-962-7901
Practice Address - Street 1:4700-K SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3416
Practice Address - Country:US
Practice Address - Phone:954-962-0040
Practice Address - Fax:954-962-7901
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56375207RI0200X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061869100Medicaid
FL09389XMedicare ID - Type Unspecified