Provider Demographics
NPI:1245233022
Name:SPENCER, JOSE ARTURO (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ARTURO
Last Name:SPENCER
Suffix:
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 1:2411 SARA RIDGE LANE
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450
Mailing Address - Country:US
Mailing Address - Phone:713-461-3573
Mailing Address - Fax:713-468-1247
Practice Address - Street 1:2411 SARA RIDGE LANE
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450
Practice Address - Country:US
Practice Address - Phone:713-461-3573
Practice Address - Fax:713-468-1247
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG15542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
300018341OtherRAILROAD MEDICARE
TX81544ROtherBLUE CROSS BLUE SHIELD
TX117144903Medicaid
300018341OtherRAILROAD MEDICARE
E10960Medicare UPIN