Provider Demographics
NPI:1093947434
Name:TODD A SPENCER, MD, PA
Entity Type:Organization
Organization Name:TODD A SPENCER, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-566-7188
Mailing Address - Street 1:PO BOX 269092
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-9092
Mailing Address - Country:US
Mailing Address - Phone:972-566-7188
Mailing Address - Fax:972-566-2312
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:SUITE C516
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2571
Practice Address - Country:US
Practice Address - Phone:972-566-7188
Practice Address - Fax:972-566-2312
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TODD A SPENCER,MD, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-19
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL38392086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0038TAOtherBCBS
TX157541702Medicaid
TX157541702Medicaid
TX0A5348Medicare PIN