Healthcare Provider Details

I. General information

NPI: 1891791505
Provider Name (Legal Business Name): STEVEN DAVID SPECTOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 07/08/2007
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 BOX 751
GOTHA FL
34734-0751
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:
Title or Position:
Credential:
Phone: