Provider Demographics
NPI:1275826133
Name:SPERO, KERRY ELIZABETH (DO)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:ELIZABETH
Last Name:SPERO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-361-5565
Mailing Address - Fax:
Practice Address - Street 1:2329 MEDICO LN STE 101
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8449
Practice Address - Country:US
Practice Address - Phone:321-361-5565
Practice Address - Fax:321-434-9530
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14502207RC0200X, 207RP1001X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022534200Medicaid
FLJD141ZOtherMEDICARE