Provider Demographics
NPI:1033139480
Name:SPRECHER, ROBERT C (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:SPRECHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 5720
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPARTMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32247-5720
Mailing Address - Country:US
Mailing Address - Phone:407-650-7129
Mailing Address - Fax:407-650-7578
Practice Address - Street 1:807 CHILDRENS WAY
Practice Address - Street 2:NEMOURS CHILDRENS CLINIC, JACKSONVILLE
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8426
Practice Address - Country:US
Practice Address - Phone:904-697-3694
Practice Address - Fax:904-697-3927
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-069095207Y00000X
FLME111289207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH364038OtherWELLCARE
OH0000000206511OtherUNISON
OH000000506212OtherANTHEM
OH000000132426OtherANTHEM
PA0019465310002Medicaid
OH5741197OtherAETNA
OH0231556Medicaid
OH733289OtherBUCKEYE
PA0019465310002Medicaid
OHSP4314691Medicare PIN
OHSP0798759Medicare PIN
OHSP0798751Medicare PIN
OHSP0798758Medicare PIN