Provider Demographics
NPI:1194173260
Name:JOSEPH SPINE, PA
Entity type:Organization
Organization Name:JOSEPH SPINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:727-202-5093
Mailing Address - Street 1:2727 W MLK BLVD
Mailing Address - Street 2:SUITE 590
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6383
Mailing Address - Country:US
Mailing Address - Phone:813-534-6269
Mailing Address - Fax:813-870-0008
Practice Address - Street 1:2727 W MLK BLVD
Practice Address - Street 2:STE 590
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6383
Practice Address - Country:US
Practice Address - Phone:813-534-6269
Practice Address - Fax:813-870-0008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-31
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101718207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty