Healthcare Provider Details

I. General information

NPI: 1265494702
Provider Name (Legal Business Name): DRS CLACK SPENCER WHITE & MCCORMACK PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 WEBBER ST
SARASOTA FL
34239-5237
US

IV. Provider business mailing address

2001 WEBBER ST
SARASOTA FL
34239-5237
US

V. Phone/Fax

Practice location:
  • Phone: 941-362-8900
  • Fax: 941-362-8933
Mailing address:
  • Phone: 941-362-8900
  • Fax: 941-362-8987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number800000813
License Number StateFL

VIII. Authorized Official

Name: DR. J ROBERT SPENCER
Title or Position: TREASURER
Credential: M.D.
Phone: 941-362-8900