Healthcare Provider Details

I. General information

NPI: 1871578021
Provider Name (Legal Business Name): MARTIN JAY SPITZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 CLEMENT ST
SAN FRANCISCO CA
94121-1545
US

IV. Provider business mailing address

108 AUTUMN RUN WAY
NAPA CA
94558-6724
US

V. Phone/Fax

Practice location:
  • Phone: 415-540-1027
  • Fax: 415-750-3386
Mailing address:
  • Phone: 707-226-7755
  • Fax: 707-226-3581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG11391
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: