Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 04-33344 | KS |
N | 208000000X | Pediatrician | 2008021141 | MO |
N | 208000000X | Pediatrician | ME96905 | FL |
Y | 2080P0006X | Developmental - Behavioral Pediatrician | ME133729 | FL |
NPI | 1003927112 |
---|---|
Provider Name | Dr. Lisa Santos Spector |
First Address | Jacksonville, FL 32256-0532 |
Second Address | Orlando, FL 32827-7402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 26/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
022874200 | (05) | FL |
2763362-00 | (05) | FL |
I21783 | (02) | FL |