Provider Demographics
NPI:1306877147
Name:SPENCER, LINDO TERRY JR (MD)
Entity type:Individual
Prefix:DR
First Name:LINDO
Middle Name:TERRY
Last Name:SPENCER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LINDO
Other - Middle Name:T
Other - Last Name:SPENCER
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1137
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32902-1137
Mailing Address - Country:US
Mailing Address - Phone:321-952-9696
Mailing Address - Fax:321-952-7937
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-6195
Practice Address - Fax:401-444-6378
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME129576208000000X, 2080P0214X
RIMD17247208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020001900Medicaid
FL256665600Medicaid
G91696Medicare UPIN
FLE2457Medicare ID - Type Unspecified