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General NPI Number Information
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NPI Number | 1154368884
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Entity Type | Organization
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Legal Business Name | STEPHEN A SPENCER MD.,PA
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1111 TAMIAMI TRL
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City | PUNTA GORDA
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State | FL
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Zip | 33950-5526
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Country | US
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Telephone | 941-833-4400
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Fax | 941-833-4401
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Provider Business Mailing Address
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Address Line | 1111 TAMIAMI TRL
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City | PUNTA GORDA
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State | FL
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Zip | 33950-5526
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Country | US
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Telephone | 941-833-4400
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Fax | 941-833-4401
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN
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Name | STEPHEN A SPENCER
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Credential | MD
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Telephone | 941-833-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME0047672
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License Number State | FL
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