Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | MD.40572 | AL |
N | 207N00000X | Dermatologist | ME150980 | FL |
N | 207ND0101X | MOHS-Micrographic Surgeon | MD.40572 | AL |
Y | 207ND0101X | MOHS-Micrographic Surgeon | ME150980 | FL |
N | 207NS0135X | Procedural Dermatology | MD.40572 | AL |
NPI | 1477932341 |
---|---|
Provider Name | Spencer Bezalel |
First Address | Lutz, FL 33558-4880 |
Second Address | Sarasota, FL 34239-5200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2015 |
Last Update Date | 27/10/2021 |