Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 2588 | AZ |
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 41577 | CO |
N | 208D00000X | General Practice Physician | 2588 | AZ |
N | 208D00000X | General Practice Physician | 41577 | CO |
NPI | 1477643799 |
---|---|
Provider Name | Dr. Ilene M. Spector |
First Address | Crested Butte, CO 81224 |
Second Address | Crested Butte, CO 81224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2006 |
Last Update Date | 26/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E68579 | (02) | AZ |