Healthcare Provider Details

I. General information

NPI: 1689766420
Provider Name (Legal Business Name): DEBBIE SPIVAK, DPM, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 NW 40TH TER STE C
GAINESVILLE FL
32605-3500
US

IV. Provider business mailing address

2205 NW 40TH TER STE C
GAINESVILLE FL
32605-3500
US

V. Phone/Fax

Practice location:
  • Phone: 352-380-2300
  • Fax:
Mailing address:
  • Phone: 352-380-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO2878
License Number StateFL

VIII. Authorized Official

Name: DEBBIE ANN SPIVAK
Title or Position: PRESIDENT OWNER
Credential:
Phone: 352-380-2300