Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MD17247 | RI |
N | 208000000X | Pediatrician | ME129576 | FL |
N | 2080P0214X | Pediatric Pulmonologist | ME129576 | FL |
NPI | 1306877147 |
---|---|
Provider Name | Dr. Lindo Terry Spencer JR. |
First Address | Melbourne, FL 32902-1137 |
Second Address | Providence, RI 02903-4923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 29/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020001900 | (05) | FL |
G91696 | (02) |