Provider Demographics
NPI:1801961818
Name:IVAN C SPECTOR MD PA
Entity type:Organization
Organization Name:IVAN C SPECTOR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SPECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:713-963-0769
Mailing Address - Street 1:3100 WESLAYAN ST
Mailing Address - Street 2:#350
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-5727
Mailing Address - Country:US
Mailing Address - Phone:713-963-0769
Mailing Address - Fax:713-963-8536
Practice Address - Street 1:3100 WESLAYAN ST
Practice Address - Street 2:#350
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5727
Practice Address - Country:US
Practice Address - Phone:713-963-0769
Practice Address - Fax:713-963-8536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG56332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00F89FOtherBCBS
TX122926202Medicaid
TX00F89FOtherRR MEDICARE
TX00F89FOtherRR MEDICARE