Healthcare Provider Details

I. General information

NPI: 1275533705
Provider Name (Legal Business Name): ROGER DANIEL SPITZER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 11/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700-K SHERIDAN ST
HOLLYWOOD FL
33021-3416
US

IV. Provider business mailing address

4430 SHERIDAN ST STE A
HOLLYWOOD FL
33021-3546
US

V. Phone/Fax

Practice location:
  • Phone: 954-962-0040
  • Fax: 954-962-7901
Mailing address:
  • Phone: 954-962-0040
  • Fax: 954-962-7901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME56375
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: