Provider Demographics
NPI:1982892857
Name:JOSEPH G SPANO MD PA
Entity Type:Organization
Organization Name:JOSEPH G SPANO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:G
Authorized Official - Last Name:SPANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-263-4470
Mailing Address - Street 1:130 TAMIAMI TRL N
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-6224
Mailing Address - Country:US
Mailing Address - Phone:239-263-4470
Mailing Address - Fax:239-403-1655
Practice Address - Street 1:130 TAMIAMI TRL N
Practice Address - Street 2:SUITE 130
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6224
Practice Address - Country:US
Practice Address - Phone:239-263-4470
Practice Address - Fax:239-403-1655
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSEPH G SPANO MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-04
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME15497207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL490004079OtherRAILROAD MEDICARE
FL048570500Medicaid
FL1982892857OtherRAILROAD MEDICARE
FL490004079OtherRAILROAD MEDICARE