Healthcare Provider Details

I. General information

NPI: 1386630259
Provider Name (Legal Business Name): JAY MYRON SPECTOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 12/03/2009
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:
Title or Position:
Credential:
Phone: