Provider Demographics
NPI:1063495877
Name:SPENCER, JAMES D (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:SPENCER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48811-9693
Mailing Address - Country:US
Mailing Address - Phone:989-584-6139
Mailing Address - Fax:989-584-2541
Practice Address - Street 1:406 E ELM ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:MI
Practice Address - Zip Code:48811-9693
Practice Address - Country:US
Practice Address - Phone:989-584-6139
Practice Address - Fax:989-584-2541
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009107207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200289920Medicaid
IN200289920Medicaid
IN184520EEEMedicare PIN