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General NPI Number Information
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NPI Number | 1841244266
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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 | 05/20/2006
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Last Update Date | 07/06/2010
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Provider Practice Location Address
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Address Line | 1617 TAMIAMI TRL
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City | PORT CHARLOTTE
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State | FL
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Zip | 33948-1040
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Country | US
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Telephone | 941-613-2400
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Fax | 941-613-2401
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Provider Business Mailing Address
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Address Line | PO BOX 494710
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City | PORT CHARLOTTE
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State | FL
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Zip | 33949-1040
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Country | US
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Telephone | 941-613-2400
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Fax | 941-613-2401
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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 PA
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Telephone | 941-613-2400
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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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