Provider Demographics
NPI:1750338885
Name:SPIRES, KEVIN SCOTT (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:SCOTT
Last Name:SPIRES
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 1:7614 JACQUE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7195
Mailing Address - Country:US
Mailing Address - Phone:727-862-8548
Mailing Address - Fax:727-863-4530
Practice Address - Street 1:7614 JACQUE RD
Practice Address - Street 2:SUITE A
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7195
Practice Address - Country:US
Practice Address - Phone:727-862-8548
Practice Address - Fax:727-863-4530
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 84672208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264118600Medicaid
FL264118600Medicaid
133142Medicare ID - Type Unspecified