Provider Demographics
NPI:1639191778
Name:SPITZ, ANITA D (MD)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:D
Last Name:SPITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:500 N WASHINGTON AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2759
Mailing Address - Country:US
Mailing Address - Phone:321-383-0112
Mailing Address - Fax:321-383-0229
Practice Address - Street 1:500 N WASHINGTON AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2759
Practice Address - Country:US
Practice Address - Phone:321-383-0112
Practice Address - Fax:321-383-0229
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME58817207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11861OtherBCBS
FL11861OtherBCBS
E75473Medicare UPIN