Healthcare Provider Details

I. General information

NPI: 1083896591
Provider Name (Legal Business Name): GIOVANNI S. SPATOLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12500 S APOPKA VINELAND RD
ORLANDO FL
32836-6723
US

IV. Provider business mailing address

901 N LAKE DESTINY RD SUITE 400
MAITLAND FL
32751-4844
US

V. Phone/Fax

Practice location:
  • Phone: 407-934-2273
  • Fax: 407-934-2279
Mailing address:
  • Phone: 407-200-2860
  • Fax: 407-200-1365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME 100073
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: