Provider Demographics
NPI:1376704528
Name:HARRIS, SPENCER MATTHEW (DO)
Entity Type:Individual
Prefix:MR
First Name:SPENCER
Middle Name:MATTHEW
Last Name:HARRIS
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 1:203 S WATER ST
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230-1347
Mailing Address - Country:US
Mailing Address - Phone:606-638-1100
Mailing Address - Fax:606-638-1300
Practice Address - Street 1:203 S WATER ST
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-1347
Practice Address - Country:US
Practice Address - Phone:606-638-1100
Practice Address - Fax:606-638-1300
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03382207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
K031090Medicare PIN