MEDICARE: DR. PAUL MITCHELL SPECTOR D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	0102023076	VA

General Provider Information

NPI Number	:	1134285927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL MITCHELL SPECTOR D.O.

Provider Business Mailing Address
First Line	:	7329 BOULDER VIEW LN
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-4953
Country	:	US
Telephone Number	:	804-320-8570
Fax Number	:	804-320-8572

Provider Business Practice Location Address
First Line	:	7329 BOULDER VIEW LN
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-4953
Country	:	US
Telephone Number	:	804-320-8570
Fax Number	:	804-320-8572

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	07/08/2007

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