Provider Demographics
NPI:1154820157
Name:SPENCER, DAVID VINCENT (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:VINCENT
Last Name:SPENCER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 S BALTIMORE ST STE B
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-4508
Mailing Address - Country:US
Mailing Address - Phone:660-665-3599
Mailing Address - Fax:660-665-3570
Practice Address - Street 1:1605 S BALTIMORE ST STE B
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-4508
Practice Address - Country:US
Practice Address - Phone:660-627-3363
Practice Address - Fax:660-627-3367
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016020994207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine