Provider Demographics
NPI:1104809920
Name:SPIRO, DAVID MARK (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MARK
Last Name:SPIRO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:MAIL CODE CDW-EM
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-0828
Mailing Address - Fax:503-494-4997
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:MAIL CODE CDW-EM
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-0828
Practice Address - Fax:503-494-4997
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CT0413322080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F74347Medicare UPIN