Provider Demographics
NPI:1558482802
Name:SPENCER, LEIGH (PA)
Entity Type:Individual
Prefix:MISS
First Name:LEIGH
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:222 LAS COLINAS BLVD W
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-5421
Mailing Address - Country:US
Mailing Address - Phone:972-957-3000
Mailing Address - Fax:972-236-0096
Practice Address - Street 1:2982 FULTON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77009-5738
Practice Address - Country:US
Practice Address - Phone:713-231-1346
Practice Address - Fax:972-236-0096
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA00409363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA00409OtherMEDICAL LICENSE