Healthcare Provider Details

I. General information

NPI: 1336113190
Provider Name (Legal Business Name): GEORGE SPOTO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6006 49TH ST N SUITE 310
ST PETERSBURG FL
33709-2148
US

IV. Provider business mailing address

6006 49TH ST N SUITE 310
ST PETERSBURG FL
33709-2148
US

V. Phone/Fax

Practice location:
  • Phone: 727-490-5040
  • Fax: 727-490-5045
Mailing address:
  • Phone: 727-490-5040
  • Fax: 727-490-5045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME33068
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: