Provider Demographics
NPI:1346252855
Name:SPENCER, ROBERT A (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
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:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-5853
Mailing Address - Fax:740-374-6332
Practice Address - Street 1:304 MAIN STREET
Practice Address - Street 2:CALDWELL CLINIC
Practice Address - City:CALDWELL
Practice Address - State:OH
Practice Address - Zip Code:43724-1396
Practice Address - Country:US
Practice Address - Phone:740-732-2339
Practice Address - Fax:740-732-2350
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-4380207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0668282Medicaid
OH7127002Medicare PIN
OHA17005Medicare UPIN
0601357Medicare PIN