Provider Demographics
NPI:1730102385
Name:SPENCER, JAMES MONTGOMERY (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MONTGOMERY
Last Name:SPENCER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5253 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-8141
Mailing Address - Country:US
Mailing Address - Phone:727-388-6982
Mailing Address - Fax:727-323-7001
Practice Address - Street 1:5013 96TH ST E
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-1318
Practice Address - Country:US
Practice Address - Phone:727-388-6982
Practice Address - Fax:727-323-7001
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68471207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26331XMedicare PIN
FLF27675Medicare UPIN