Provider Demographics
NPI:1114906286
Name:SPECTOR, FREDERIC C (DPM)
Entity Type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:C
Last Name:SPECTOR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 COMMERCIAL DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406
Mailing Address - Country:US
Mailing Address - Phone:912-354-3668
Mailing Address - Fax:912-354-0662
Practice Address - Street 1:352 COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406
Practice Address - Country:US
Practice Address - Phone:912-354-3668
Practice Address - Fax:912-354-0662
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA484213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000247585AMedicaid
GA000247585AMedicaid