1376875344 NPI number — CARLOS E. SPERA, MD, PA

Table of content: (NPI 1376875344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376875344 NPI number — CARLOS E. SPERA, MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARLOS E. SPERA, MD, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376875344
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15385
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27704-0385
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-477-5152
Provider Business Mailing Address Fax Number:
919-477-5474

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12575 ORANGE DRIVE #303
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAVIE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-577-8585
Provider Business Practice Location Address Fax Number:
954-577-8556
Provider Enumeration Date:
02/02/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MITCHELL
Authorized Official First Name:
RACHEL
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
919-477-5152

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  1196 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1196 . This is a "LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2964 . This is a "CERTIFICATE NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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