Provider Demographics
NPI:1508922451
Name:STANLEY A. SPATZ, MD, PA
Entity Type:Organization
Organization Name:STANLEY A. SPATZ, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-433-0455
Mailing Address - Street 1:601 N. FLAMINGO ROAD
Mailing Address - Street 2:SUITE 313
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028
Mailing Address - Country:US
Mailing Address - Phone:954-433-0455
Mailing Address - Fax:954-433-8771
Practice Address - Street 1:601 N. FLAMINGO ROAD
Practice Address - Street 2:SUITE 313
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028
Practice Address - Country:US
Practice Address - Phone:954-433-0455
Practice Address - Fax:954-433-8771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME22546207N00000X
FL22546207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE12064Medicare UPIN
FLK7260Medicare PIN