Provider Demographics
NPI:1417996570
Name:SPENCER, KEVIN PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:PATRICK
Last Name:SPENCER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5625 EIGER RD
Mailing Address - Street 2:STE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8976
Mailing Address - Country:US
Mailing Address - Phone:512-892-7076
Mailing Address - Fax:512-899-8460
Practice Address - Street 1:5625 EIGER RD
Practice Address - Street 2:STE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8976
Practice Address - Country:US
Practice Address - Phone:512-892-7076
Practice Address - Fax:512-899-8460
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2014-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL8515207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1235130592OtherNPI
TX8G5819Medicare PIN