Provider Demographics
NPI:1114037116
Name:SPECTOR, GUS (MD)
Entity Type:Individual
Prefix:
First Name:GUS
Middle Name:
Last Name:SPECTOR
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 1:824 MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460
Mailing Address - Country:US
Mailing Address - Phone:610-933-1133
Mailing Address - Fax:610-933-4238
Practice Address - Street 1:824 MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460
Practice Address - Country:US
Practice Address - Phone:610-933-1133
Practice Address - Fax:610-933-4238
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD011901E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006553510003Medicaid
PA0006553510003Medicaid
E55438Medicare UPIN