Provider Demographics
NPI:1396777660
Name:SPIEGEL, JERRY ALVIN (MD)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:ALVIN
Last Name:SPIEGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12705 VIA LUCIA
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-5827
Mailing Address - Country:US
Mailing Address - Phone:561-499-7979
Mailing Address - Fax:561-499-7979
Practice Address - Street 1:12705 VIA LUCIA
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-5827
Practice Address - Country:US
Practice Address - Phone:561-499-7979
Practice Address - Fax:561-499-7979
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68274207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252770700Medicaid
FLC07489Medicare UPIN
FL48476Medicare PIN