Provider Demographics
NPI:1841244266
Name:STEPHEN A SPENCER MD PA
Entity type:Organization
Organization Name:STEPHEN A SPENCER MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:941-613-2400
Mailing Address - Street 1:PO BOX 494710
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33949-1040
Mailing Address - Country:US
Mailing Address - Phone:941-613-2400
Mailing Address - Fax:941-613-2401
Practice Address - Street 1:1617 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1040
Practice Address - Country:US
Practice Address - Phone:941-613-2400
Practice Address - Fax:941-613-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0047672174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00824OtherBC/BS FLORIDA GROUP NUMBE
FLCH1886OtherRAILROAD MEDICARE GROUP
FLCH1886OtherRAILROAD MEDICARE GROUP
FLD61552Medicare UPIN