Provider Demographics
NPI:1154320877
Name:SPENNER, CRAIG WILLIAM SR (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:WILLIAM
Last Name:SPENNER
Suffix:SR
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 1:439 S KIRKWOOD RD
Mailing Address - Street 2:SIUTE 206
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-6169
Mailing Address - Country:US
Mailing Address - Phone:314-966-2010
Mailing Address - Fax:314-966-4825
Practice Address - Street 1:439 S KIRKWOOD RD
Practice Address - Street 2:SIUTE 206
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-6169
Practice Address - Country:US
Practice Address - Phone:314-966-2010
Practice Address - Fax:314-966-4825
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1A88207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO070001348OtherRAILROAD MEDICARE
MO000005003Medicare ID - Type Unspecified
MO070001348OtherRAILROAD MEDICARE
MOA09941Medicare UPIN