Healthcare Provider Details

I. General information

NPI: 1174987762
Provider Name (Legal Business Name): JAMES SPAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 N LAKEMONT AVE STE B
WINTER PARK FL
32792-3203
US

IV. Provider business mailing address

185 N LAKEMONT AVE STE B
WINTER PARK FL
32792-3203
US

V. Phone/Fax

Practice location:
  • Phone: 321-422-3660
  • Fax: 407-644-2981
Mailing address:
  • Phone: 321-422-3660
  • Fax: 407-644-2981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME156002
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: