Provider Demographics
NPI:1902879463
Name:SPECTOR, EUGENE ELLIOT (DPM)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:ELLIOT
Last Name:SPECTOR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 WEBSTER ST
Mailing Address - Street 2:SUITE 407
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2373
Mailing Address - Country:US
Mailing Address - Phone:415-923-3982
Mailing Address - Fax:415-563-9391
Practice Address - Street 1:2100 WEBSTER ST
Practice Address - Street 2:SUITE 407
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2373
Practice Address - Country:US
Practice Address - Phone:415-923-3982
Practice Address - Fax:415-563-9391
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1488213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E14881Medicaid
CA000E14881Medicaid
CA000E14880Medicare ID - Type Unspecified