Provider Demographics
NPI:1679569966
Name:SPENCER, DEBBIE PATRICIA (MD)
Entity type:Individual
Prefix:
First Name:DEBBIE
Middle Name:PATRICIA
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4503 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-6201
Mailing Address - Country:US
Mailing Address - Phone:813-684-2229
Mailing Address - Fax:813-413-8549
Practice Address - Street 1:4503 N 22ND ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-6201
Practice Address - Country:US
Practice Address - Phone:813-684-2229
Practice Address - Fax:813-413-8549
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08218100207V00000X
TXL3487207V00000X
FLME92880207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272594100Medicaid
FL272594100Medicaid
H57228Medicare UPIN