Provider Demographics
NPI:1912106717
Name:SPECTER, S.E. (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:S.E.
Middle Name:
Last Name:SPECTER
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N ROBERTSON BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1748
Mailing Address - Country:US
Mailing Address - Phone:310-409-9281
Mailing Address - Fax:
Practice Address - Street 1:201 N. ROBERTSON BLVD., SUITE 203
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1732
Practice Address - Country:US
Practice Address - Phone:310-409-9281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1073762084B0002X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084B0002XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGI053ZMedicare PIN