Healthcare Provider Details

I. General information

NPI: 1043243850
Provider Name (Legal Business Name): JAY M. SPECTOR,M.D.,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1929 AARON DR SUITE I
TOOELE UT
84074-8112
US

IV. Provider business mailing address

PO BOX 932
SANDY UT
84091-0932
US

V. Phone/Fax

Practice location:
  • Phone: 435-833-0229
  • Fax: 435-833-0231
Mailing address:
  • Phone: 801-619-2175
  • Fax: 801-553-9562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1670871205
License Number StateUT

VIII. Authorized Official

Name: JAY M SPECTOR
Title or Position: OWNER
Credential: M.D.
Phone: 435-833-0229