Provider Demographics
NPI:1417068040
Name:SPANO, JOSEPH GRIFFIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:GRIFFIN
Last Name:SPANO
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 1:130 TAMIAMI TRL N
Mailing Address - Street 2:STE 130
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-6224
Mailing Address - Country:US
Mailing Address - Phone:239-263-4470
Mailing Address - Fax:239-403-1655
Practice Address - Street 1:130 TAMIAMI TRL N
Practice Address - Street 2:STE 130
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6224
Practice Address - Country:US
Practice Address - Phone:239-263-4470
Practice Address - Fax:239-403-1655
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME15497207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL71454YMedicare ID - Type Unspecified
FLD58077Medicare UPIN