NPIMap

Organization Active NPI

Stephen a Spencer MD PA

Doing business as Coastal Dermatology and Skin Cancer Center

  • Specialist
  • Port Charlotte, FL
National Provider Identifier
1841244266
Registry record updated Jul 6, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
ME0047672 Issued in FL
Legal business name
STEPHEN A SPENCER MD PA
Doing business as
Coastal Dermatology and Skin Cancer Center
Practice address
1617 Tamiami TRL
Port Charlotte, FL 33948-1040
Phone
(941) 613-2400
Fax
(941) 613-2401
NPI assigned
May 20, 2006
Last updated
Jul 6, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Stephen A Spencer, MD PANPI 1104814235
Title
President/Physician
Phone
(941) 613-2400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X ME0047672 FL Primary

Addresses

Primary practice location

1617 Tamiami TRL
Port Charlotte, FL 33948-1040

Mailing address

PO Box 494710
Port Charlotte, FL 33949-1040
Phone (941) 613-2400

Other identifiers 2

IdentifierTypeStateIssuer
00824OtherFLBC/BS FLORIDA GROUP NUMBE
CH1886OtherFLRAILROAD MEDICARE GROUP

Other names 1

  • Coastal Dermatology and Skin Cancer Center Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278374400000",
    "number": "1841244266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 494710",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339491040",
            "telephone_number": "941-613-2400",
            "fax_number": "941-613-2401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1617 TAMIAMI TRL",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339481040",
            "telephone_number": "941-613-2400",
            "fax_number": "941-613-2401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHEN A SPENCER MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-20",
        "last_updated": "2010-07-06",
        "status": "A",
        "authorized_official_last_name": "SPENCER",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT/PHYSICIAN",
        "authorized_official_telephone_number": "941-613-2400",
        "authorized_official_credential": "MD  PA"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME0047672",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS FLORIDA GROUP NUMBE",
            "identifier": "00824",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP",
            "identifier": "CH1886",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Dermatology and Skin Cancer Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Charlotte, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.