MEDICARE: DR. JEROME J. SPUNBERG 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	2085R0001X	Radiation Oncology Physician	ME 33705	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	P01560966	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01270	OTHER	FL	FREEDOM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	61432	OTHER	FL	BCBS
4	P509193	OTHER	FL	OPTIMUM
5	5557299	OTHER	FL	AETNA
6	5719	OTHER	FL	DIMENSION HEALTH PPO
8	06724	OTHER	FL	WELLCARE
9	204358	OTHER	FL	AVMED
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902803356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEROME J. SPUNBERG M.D.

Provider Business Mailing Address
First Line	:	2234 COLONIAL BLVD
Second Line	:	ATTN: PAYER CONTRACTING & RELATIONS DEPT.
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1412
Country	:	US
Telephone Number	:	239-931-7342
Fax Number	:	239-931-7385

Provider Business Practice Location Address
First Line	:	10335 N MILITARY TRL
Second Line	:	SUITE C
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4634
Country	:	US
Telephone Number	:	561-624-1717
Fax Number	:	561-296-4270

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	10/20/2016

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