Individual
STEPHEN A SPENCER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD PA
Contact information
Practice address
1617 TAMIAMI TRL, PORT CHARLOTTE, FL 33948-1040
(941) 613-2400
Mailing address
151 SOUTHHALL LN, STE 300, MAITLAND, FL 32751-7172
(407) 875-2080
(407) 650-3455
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME0047672
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08153
BLUE CROSS/BLUE SHIELD
FL
01
—
1255052
UHC
FL
01
—
5872736
AETNA
FL
01
—
6417334
CIGNA
FL
Enumeration date
10/12/2005
Last updated
05/10/2019
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