Provider Demographics
NPI:1568407179
Name:SPICER, DARCY V (MD)
Entity Type:Individual
Prefix:DR
First Name:DARCY
Middle Name:V
Last Name:SPICER
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:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-865-3105
Mailing Address - Fax:
Practice Address - Street 1:1441 EASTLAKE AVE
Practice Address - Street 2:NOR 8302E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0112
Practice Address - Country:US
Practice Address - Phone:323-865-3105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39950207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G399500OtherBLUE SHIELD
CA00G399500OtherBLUE SHIELD
CA00G399500Medicaid
CACE1617OtherGROUP RAILROAD MEDICARE
CA1902846306OtherGROUP NPI
CAW11675OtherGROUP MEDICARE PIN
CA1356390009OtherGROUP NPI
CAW18762OtherGROUP MEDICARE
CAGR0016910OtherGROUP MEDICAID PIN
CAGR0100430OtherGROUP MEDICAL
CAWG39950BMedicare PIN
CAW18762OtherGROUP MEDICARE