Provider Demographics
NPI:1225191562
Name:SPENCER, ALLAN M (DPM)
Entity Type:Individual
Prefix:MR
First Name:ALLAN
Middle Name:M
Last Name:SPENCER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3883 MAYFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2224
Mailing Address - Country:US
Mailing Address - Phone:216-382-7840
Mailing Address - Fax:
Practice Address - Street 1:3883 MAYFIELD ROAD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44121-2224
Practice Address - Country:US
Practice Address - Phone:216-382-7840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36 00 1232213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0000001154OtherBCBS FED EMPLOYEE
OHSP 0011181Medicare ID - Type Unspecified
T 91056Medicare UPIN