=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912106717
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | S.E. SPECTER MD PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2007
-----------------------------------------------------
Last Update Date | 05/08/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 N. ROBERTSON BLVD., SUITE 203
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90211-1732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-409-9281
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 N ROBERTSON BLVD STE 203
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90211-1748
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-409-9281
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084B0002X
-----------------------------------------------------
Taxonomy Name | Obesity Medicine (Psychiatry & Neurology) Physician
-----------------------------------------------------
License Number | A107376
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | A107376
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------