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Organization
STEPHEN A SPENCER MD PA
Active
Organization
STEPHEN A SPENCER MD PA
Active
Other names
Coastal Dermatology and Skin Cancer Center
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN A SPENCER MD PA (PRESIDENT/PHYSICIAN)
(941) 613-2400
Entity
Organization
Contact information
Practice address
1617 TAMIAMI TRL, PORT CHARLOTTE, FL 33948-1040
(941) 613-2400
(941) 613-2401
Mailing address
PO BOX 494710, PORT CHARLOTTE, FL 33949-1040
(941) 613-2400
(941) 613-2401
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME0047672
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00824
BC/BS FLORIDA GROUP NUMBE
FL
01
—
CH1886
RAILROAD MEDICARE GROUP
FL
Enumeration date
05/20/2006
Last updated
07/06/2010
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