Provider Demographics
NPI:1235341645
Name:SPENCE, SCOTT A (SFIDC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:A
Last Name:SPENCE
Suffix:
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26369 PLUMERIA LN
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-6364
Mailing Address - Country:US
Mailing Address - Phone:951-461-7065
Mailing Address - Fax:
Practice Address - Street 1:USS BENFOLD (DDG 65)
Practice Address - Street 2:MEDICAL DEPARTMENT
Practice Address - City:FPO
Practice Address - State:US NAVY
Practice Address - Zip Code:AP
Practice Address - Country:US
Practice Address - Phone:619-556-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman