Provider Demographics
NPI:1982639886
Name:SPECTOR, MARK JAY (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAY
Last Name:SPECTOR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3112 N JUPITER RD
Mailing Address - Street 2:STE. 213 A
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-6578
Mailing Address - Country:US
Mailing Address - Phone:972-530-4655
Mailing Address - Fax:972-495-9500
Practice Address - Street 1:3112 N JUPITER RD
Practice Address - Street 2:STE. 213 A
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-6578
Practice Address - Country:US
Practice Address - Phone:972-530-4655
Practice Address - Fax:972-495-9500
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1034213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018658701Medicaid
TXOODX34Medicare ID - Type UnspecifiedMEDICARE
TX018658701Medicaid