Provider Demographics
NPI:1235130154
Name:SPENCER, ROBERT H (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:SPENCER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 NORTH E STREET
Mailing Address - Street 2:SUITE 333
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501
Mailing Address - Country:US
Mailing Address - Phone:850-444-1717
Mailing Address - Fax:850-857-1747
Practice Address - Street 1:1717 N E ST
Practice Address - Street 2:SUITE 331
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-6376
Practice Address - Country:US
Practice Address - Phone:850-444-1717
Practice Address - Fax:850-857-1747
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME95966207RC0000X
AL26952207RC0000X
MS10793174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009938344Medicaid
FL276009600Medicaid
AL009938344Medicaid
AL102I062438Medicare UPIN
FL276009600Medicaid