Healthcare Provider Details

I. General information

NPI: 1033160718
Provider Name (Legal Business Name): VINCENT M SPOTO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S ORLANDO AVE 205
WINTER PARK FL
32789-5543
US

IV. Provider business mailing address

1400 S ORLANDO AVE 205
WINTER PARK FL
32789-5543
US

V. Phone/Fax

Practice location:
  • Phone: 407-629-9400
  • Fax:
Mailing address:
  • Phone: 407-629-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME0058010
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: