Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | D0015375 | MD |
NPI | 1033105457 |
---|---|
Provider Name | Dr. David Allen Spott |
First Address | Clinton, MD 20735-2508 |
Second Address | Clinton, MD 20735-2508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B92767 | (02) | MD |