Provider Demographics
NPI:1912073032
Name:SPECTOR, ROBERT IRA (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:IRA
Last Name:SPECTOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
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:310-286-7989
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG24756207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA90891Medicare UPIN
G24756Medicare ID - Type Unspecified