Provider Demographics
NPI:1518239391
Name:SPENCE, COURTNEY (DO)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:SPENCE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 YELLOWSTONE AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-9309
Mailing Address - Country:US
Mailing Address - Phone:307-578-2975
Mailing Address - Fax:
Practice Address - Street 1:424 YELLOWSTONE AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-9309
Practice Address - Country:US
Practice Address - Phone:307-578-2975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12564208M00000X
WY10305A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist