Provider Demographics
NPI:1124005327
Name:SPENCER, ROGER ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:ALLEN
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:PO BOX 650426
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0426
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:
Practice Address - Street 1:13601 PRESTON RD
Practice Address - Street 2:SUITE 1000W
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-4911
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0838207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120508005Medicaid
TX8S5358OtherBCBS
TXP00301055OtherRAILROAD MEDICARE
TXP00301055OtherRAILROAD MEDICARE
TX8S5358OtherBCBS