Provider Demographics
NPI:1215941414
Name:SPALLINO, JOHN FRANK (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:FRANK
Last Name:SPALLINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10307 LAKE GROVE DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-2506
Mailing Address - Country:US
Mailing Address - Phone:813-920-3212
Mailing Address - Fax:
Practice Address - Street 1:10307 LAKE GROVE DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-2506
Practice Address - Country:US
Practice Address - Phone:813-920-3212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67629207R00000X
NY188271207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F29084Medicare UPIN