Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 5101015501 | MI |
NPI | 1457563959 |
---|---|
Provider Name | Dr. James Anthony Spoto |
First Address | Wyoming, MI 49519-9606 |
Second Address | Grand Rapids, MI 49546-8371 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 05/12/2017 |