Provider Demographics
NPI:1821401613
Name:ANGELA S. SPENCER M.D, PA
Entity Type:Organization
Organization Name:ANGELA S. SPENCER M.D, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-652-9575
Mailing Address - Street 1:105 BRANDY CREEK CIR SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-2331
Mailing Address - Country:US
Mailing Address - Phone:321-652-9575
Mailing Address - Fax:321-499-4437
Practice Address - Street 1:105 BRANDY CREEK CIR SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-2331
Practice Address - Country:US
Practice Address - Phone:321-652-9575
Practice Address - Fax:321-499-4437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL933022084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty