Basic Information
| Provider Information | |||||||||
| NPI: | 1033270251 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPERA | ||||||||
| FirstName: | CARLOS | ||||||||
| MiddleName: | ERNESTO | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12575 ORANGE DR | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333304302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545778585 | ||||||||
| FaxNumber: | 9545778556 | ||||||||
| Practice Location | |||||||||
| Address1: | 12575 ORANGE DR | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333304302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545778585 | ||||||||
| FaxNumber: | 9545778556 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 08/25/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0122X | ME73811 | FL | Y | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery |
No ID Information.