Provider Demographics
NPI:1689766420
Name:DEBBIE SPIVAK, DPM, PA
Entity Type:Organization
Organization Name:DEBBIE SPIVAK, DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SPIVAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-380-2300
Mailing Address - Street 1:2205 NW 40TH TER
Mailing Address - Street 2:STE C
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-3500
Mailing Address - Country:US
Mailing Address - Phone:352-380-2300
Mailing Address - Fax:
Practice Address - Street 1:2205 NW 40TH TER
Practice Address - Street 2:STE C
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3500
Practice Address - Country:US
Practice Address - Phone:352-380-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2878213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U81535Medicare UPIN
FL65680Medicare ID - Type Unspecified