Provider Demographics
NPI:1770862492
Name:ROBERT SPECTOR, M.D., A PROFESSIONAL CORP.
Entity Type:Organization
Organization Name:ROBERT SPECTOR, M.D., A PROFESSIONAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:IRA
Authorized Official - Last Name:SPECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-552-2899
Mailing Address - Street 1:2080 CENTURY PARK EAST
Mailing Address - Street 2:SUITE #1202
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067
Mailing Address - Country:US
Mailing Address - Phone:310-552-2899
Mailing Address - Fax:310-286-7989
Practice Address - Street 1:2080 CENTURY PARK EAST
Practice Address - Street 2:SUITE #1202
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067
Practice Address - Country:US
Practice Address - Phone:310-552-2899
Practice Address - Fax:310-552-2899
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBERT SPECTOR, M.D. A PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-11
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG24756207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA90891Medicare UPIN