Provider Demographics
NPI:1063429769
Name:SPECTOR, WILLIAM BRUCE (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRUCE
Last Name:SPECTOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 HAZARD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-5446
Mailing Address - Country:US
Mailing Address - Phone:860-696-2380
Mailing Address - Fax:860-745-3864
Practice Address - Street 1:100 HAZARD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-5446
Practice Address - Country:US
Practice Address - Phone:860-696-2380
Practice Address - Fax:860-745-3864
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2013-07-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT026154208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1261544Medicaid
CT1261544Medicaid
CT010000736Medicare ID - Type Unspecified