Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DN 4852 | FL |
NPI | 1063452134 |
---|---|
Provider Name | Roger J Spott |
First Address | Boca Raton, FL 33433-7407 |
Second Address | Delray Beach, FL 33445-4637 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 18/10/2011 |