Healthcare Provider Details

I. General information

NPI: 1073045647
Provider Name (Legal Business Name): KATHERINE SPECHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2017
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 NORTH TENAYA WAY SUITE 508
LAS VEGAS NV
89128
US

IV. Provider business mailing address

PO BOX 100744
ATLANTA GA
30384-0744
US

V. Phone/Fax

Practice location:
  • Phone: 702-962-2300
  • Fax: 702-962-2301
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberDO3770
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: