Provider Demographics
NPI:1043650161
Name:EDWARD L. SPENCER, M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:EDWARD L. SPENCER, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-425-3820
Mailing Address - Street 1:450 N BEDFORD DR STE 309
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4307
Mailing Address - Country:US
Mailing Address - Phone:310-425-3820
Mailing Address - Fax:855-729-4884
Practice Address - Street 1:450 N BEDFORD DR STE 309
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4307
Practice Address - Country:US
Practice Address - Phone:310-425-3820
Practice Address - Fax:855-729-4884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1067292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty