MEDICARE: GEORGE SPOTO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	ME33068	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	62134	OTHER	FL	BCBS
2	211416	OTHER	FL	WELLCARE
3	0078127	OTHER	FL	CIGNA
4	202698	OTHER	FL	AVMED
5	211416	OTHER	FL	STAYWELL
6	3306330	OTHER	FL	AETNA
7	380115	OTHER	FL	UNITED

General Provider Information

NPI Number	:	1336113190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE SPOTO MD

Provider Business Mailing Address
First Line	:	6006 49TH ST N
Second Line	:	SUITE 310
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-2148
Country	:	US
Telephone Number	:	727-490-5040
Fax Number	:	727-490-5045

Provider Business Practice Location Address
First Line	:	6006 49TH ST N
Second Line	:	SUITE 310
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-2148
Country	:	US
Telephone Number	:	727-490-5040
Fax Number	:	727-490-5045

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2006
Last Update Date	:	11/30/2007

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Directions to “ GEORGE SPOTO MD” Practice Location

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