Provider Demographics
NPI:1386048684
Name:SPENCE, WALTER SUTTON III (PA-C)
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:SUTTON
Last Name:SPENCE
Suffix:III
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:6702 MARINA POINTE VILLAGE CT
Mailing Address - Street 2:APT 301
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-9021
Mailing Address - Country:US
Mailing Address - Phone:931-409-7752
Mailing Address - Fax:
Practice Address - Street 1:2020 59TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-4604
Practice Address - Country:US
Practice Address - Phone:941-792-6611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9108341363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant