Healthcare Provider Details

I. General information

NPI: 1215117650
Provider Name (Legal Business Name): SPETMAN AND IVEY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 EL CHICO TRL
WILLOW PARK TX
76087-8865
US

IV. Provider business mailing address

132 EL CHICO TRL
WILLOW PARK TX
76087-8865
US

V. Phone/Fax

Practice location:
  • Phone: 817-441-9252
  • Fax:
Mailing address:
  • Phone: 817-441-9252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberH3527
License Number StateTX

VIII. Authorized Official

Name: DR. KAREN L SPETMAN
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 817-441-9252