MEDICARE: DR. ROGER SPENCER M.D.

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	ME48318	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	02293	OTHER	FL	BCBS FLORIDA

General Provider Information

NPI Number	:	1578523759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER SPENCER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 24
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32402-0024
Country	:	US
Telephone Number	:	850-215-7963
Fax Number	:

Provider Business Practice Location Address
First Line	:	233 W 14TH ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-2205
Country	:	US
Telephone Number	:	850-215-7963
Fax Number	:	800-260-2711

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	05/15/2023

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