Provider Demographics
NPI:1134143605
Name:SPENCER, DAVID M (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:M
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 1:765 HIGHLAND OAKS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-7101
Mailing Address - Country:US
Mailing Address - Phone:336-760-4004
Mailing Address - Fax:336-760-6632
Practice Address - Street 1:765 HIGHLAND OAKS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-7101
Practice Address - Country:US
Practice Address - Phone:336-760-4004
Practice Address - Fax:336-760-6632
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC400362174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8978751Medicaid
NC8978751Medicaid
NC2198194AMedicare ID - Type Unspecified
NC8978751Medicaid