Provider Demographics
NPI:1104864388
Name:SPENCER, SCOTT EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:EDWARD
Last Name:SPENCER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 E 29TH ST
Mailing Address - Street 2:260
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2587
Mailing Address - Country:US
Mailing Address - Phone:979-774-0012
Mailing Address - Fax:979-774-4636
Practice Address - Street 1:2700 E 29TH ST
Practice Address - Street 2:260
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2587
Practice Address - Country:US
Practice Address - Phone:979-774-0012
Practice Address - Fax:979-774-4636
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1758207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143734501Medicaid
TX290014262OtherRAILROAD MEDICARE
TX290014262OtherRAILROAD MEDICARE
TX143734501Medicaid