Provider Demographics
NPI:1205868106
Name:SPECTOR, MARC P (DPM)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:P
Last Name:SPECTOR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18842 S MEMORIAL DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4229
Mailing Address - Country:US
Mailing Address - Phone:281-540-2234
Mailing Address - Fax:281-540-2776
Practice Address - Street 1:18842 S MEMORIAL DR
Practice Address - Street 2:SUITE 204
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4229
Practice Address - Country:US
Practice Address - Phone:281-540-2234
Practice Address - Fax:281-540-2776
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX0660213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U64XOtherMEDICARE PTAN
TX112203801Medicaid
TX00ET48OtherMEDICARE PTAN
TX00ET48OtherMEDICARE PTAN
TX00U64XOtherMEDICARE PTAN
TXT16033Medicare UPIN