MEDICARE: DANIEL VINCENT SPOTO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME0044580	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30742	OTHER	FL	BLUECROSS BLUESHIELD

General Provider Information

NPI Number	:	1306831672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL VINCENT SPOTO MD

Provider Business Mailing Address
First Line	:	2650 BAHIA VISTA ST
Second Line	:	STE 201
City	:	SARASOTA
State	:	FL
Zip	:	34239-2635
Country	:	US
Telephone Number	:	941-957-1150
Fax Number	:	941-957-1311

Provider Business Practice Location Address
First Line	:	2650 BAHIA VISTA ST
Second Line	:	STE 201
City	:	SARASOTA
State	:	FL
Zip	:	34239-2635
Country	:	US
Telephone Number	:	941-957-1150
Fax Number	:	941-957-1311

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	07/08/2007

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