Provider Demographics
NPI:1437348950
Name:SPENCER, PHILEMON THEOLOGOS (MD)
Entity Type:Individual
Prefix:
First Name:PHILEMON
Middle Name:THEOLOGOS
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 1:610 N ALMA SCHOOL RD STE 48
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-3689
Mailing Address - Country:US
Mailing Address - Phone:480-248-2440
Mailing Address - Fax:855-551-4501
Practice Address - Street 1:610 N ALMA SCHOOL RD STE 48
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-3689
Practice Address - Country:US
Practice Address - Phone:480-248-2440
Practice Address - Fax:855-551-4501
Is Sole Proprietor?:No
Enumeration Date:2007-10-21
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ54349207Q00000X, 207P00000X
AL29845207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALR9521Medicaid