Provider Demographics
NPI:1730102385
Name:SPENCER, JAMES MONTGOMERY (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MONTGOMERY
Last Name:SPENCER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1306 CONCOURSE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:21090-1033
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:813-341-3259
Practice Address - Street 1:6600 UNIVERSITY PKWY STE 302
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-9048
Practice Address - Country:US
Practice Address - Phone:941-800-5001
Practice Address - Fax:941-800-5012
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME68471207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26331XMedicare PIN
FLF27675Medicare UPIN