Provider Demographics
NPI:1578523759
Name:SPENCER, ROGER (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:
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:PO BOX 24
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32402-0024
Mailing Address - Country:US
Mailing Address - Phone:850-215-7963
Mailing Address - Fax:
Practice Address - Street 1:233 W 14TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2205
Practice Address - Country:US
Practice Address - Phone:850-215-7963
Practice Address - Fax:800-260-2711
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48318207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048878000Medicaid
FL02293OtherBCBS FLORIDA
FL02293OtherBCBS FLORIDA
FL02293AMedicare ID - Type Unspecified