Healthcare Provider Details

I. General information

NPI: 1548619612
Provider Name (Legal Business Name): JEFFREY SPIRO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL MEDICAL CENTER SAN DIEGO 34800 BOB WILSON DRIVE
SAN DIEGO CA
92134-5000
US

IV. Provider business mailing address

NAVAL MEDICAL CTR 34800 BOB WILSON DRIVE
SAN DIEGO CA
92134-5000
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-6827
  • Fax: 619-532-7508
Mailing address:
  • Phone: 619-532-6827
  • Fax: 619-532-7508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101262932
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number0101262932
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: