Healthcare Provider Details

I. General information

NPI: 1073632139
Provider Name (Legal Business Name): S. DAVID SPECTOR CARDIOVASCULAR SURGERY P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE SUITE 308
ORLANDO FL
32804-4603
US

IV. Provider business mailing address

PO BOV 751
GOTHA FL
34734
US

V. Phone/Fax

Practice location:
  • Phone: 407-896-8585
  • Fax: 407-896-8546
Mailing address:
  • Phone: 407-896-8585
  • Fax: 407-896-8546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME17472
License Number StateFL

VIII. Authorized Official

Name: DR. S DAVID SPECTOR
Title or Position: OWNER
Credential: MD
Phone: 407-896-8585