Healthcare Provider Details

I. General information

NPI: 1902803356
Provider Name (Legal Business Name): JEROME J. SPUNBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10335 N MILITARY TRL SUITE C
PALM BEACH GARDENS FL
33410-4634
US

IV. Provider business mailing address

2234 COLONIAL BLVD ATTN: PAYER CONTRACTING & RELATIONS DEPT.
FORT MYERS FL
33907-1412
US

V. Phone/Fax

Practice location:
  • Phone: 561-624-1717
  • Fax: 561-296-4270
Mailing address:
  • Phone: 239-931-7342
  • Fax: 239-931-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME 33705
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: