Provider Demographics
NPI:1447218904
Name:SPORN, PAUL A (MD)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:A
Last Name:SPORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:A
Other - Last Name:SPORN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PA
Mailing Address - Street 1:2727 W DR MARTIN LUTHER KING BLVD
Mailing Address - Street 2:STE 630
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6378
Mailing Address - Country:US
Mailing Address - Phone:813-876-6000
Mailing Address - Fax:813-876-0590
Practice Address - Street 1:2727 W DR MARTIN LUTHER KING BLVD
Practice Address - Street 2:STE 630
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6378
Practice Address - Country:US
Practice Address - Phone:813-876-6000
Practice Address - Fax:813-876-0590
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46290207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044500200Medicaid
FL02451Medicare PIN
D20745Medicare UPIN