Provider Demographics
NPI:1912281668
Name:SPOTO, ANGELO PETER JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:PETER
Last Name:SPOTO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 HOLLINGSWORTH HILL AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-3236
Mailing Address - Country:US
Mailing Address - Phone:863-686-2046
Mailing Address - Fax:
Practice Address - Street 1:2515 HOLLINGSWORTH HILL AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-3236
Practice Address - Country:US
Practice Address - Phone:863-686-2046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME7737207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME7737OtherFL LISCENSE
5500000029621592OtherDCN
FLD56447Medicare UPIN