Provider Demographics
NPI:1366556136
Name:SPINNER, IRA (DPM)
Entity type:Individual
Prefix:
First Name:IRA
Middle Name:
Last Name:SPINNER
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 1:10075 JOG RD
Mailing Address - Street 2:STE 208
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3535
Mailing Address - Country:US
Mailing Address - Phone:561-734-4867
Mailing Address - Fax:561-736-7433
Practice Address - Street 1:10075 JOG RD
Practice Address - Street 2:STE 208
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3536
Practice Address - Country:US
Practice Address - Phone:561-734-4867
Practice Address - Fax:561-736-7433
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2393213E00000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65312OtherBLUE CROSS BLUE SHIELD
FL390148300Medicaid
FL4436420001Medicare NSC
FL65312Medicare PIN
FL65312VMedicare PIN
U35922Medicare UPIN