Provider Demographics
NPI:1386630259
Name:SPECTOR, JAY MYRON (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:MYRON
Last Name:SPECTOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 932
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84091-0932
Mailing Address - Country:US
Mailing Address - Phone:801-619-2175
Mailing Address - Fax:801-553-9562
Practice Address - Street 1:1929 AARON DR
Practice Address - Street 2:SUITE I
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-8112
Practice Address - Country:US
Practice Address - Phone:435-833-0229
Practice Address - Fax:435-833-0231
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1670871205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT$$$$$$$$$001Medicaid
UT$$$$$$$$$001Medicaid
UT005810201Medicare PIN