Provider Demographics
NPI:1952313173
Name:SPENCE, MARK ROHAN
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ROHAN
Last Name:SPENCE
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MARK
Other - Middle Name:ROHAN
Other - Last Name:SPENCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1190 NW 95TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33150-2064
Mailing Address - Country:US
Mailing Address - Phone:305-693-0000
Mailing Address - Fax:888-717-7671
Practice Address - Street 1:1190 NW 95TH ST STE 203
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-2064
Practice Address - Country:US
Practice Address - Phone:305-693-0000
Practice Address - Fax:888-717-7671
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74724174400000X
FLME-74724207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255064400Medicaid
FL43740Medicare ID - Type UnspecifiedPROVIDER NUMBER
FLG99494Medicare UPIN