Provider Demographics
NPI:1578530275
Name:SPENCER, EDWIN EARL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:EARL
Last Name:SPENCER
Suffix:JR
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 1:260 FORT SANDERS WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3355
Mailing Address - Country:US
Mailing Address - Phone:865-558-4400
Mailing Address - Fax:865-558-4421
Practice Address - Street 1:260 FORT SANDERS WEST BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922
Practice Address - Country:US
Practice Address - Phone:865-558-4400
Practice Address - Fax:865-558-4421
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD36487207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN414315675OtherTRICARE
TNTN01C3OtherJOHN DEERE HEALTHCARE
TNTN01C4OtherJOHN DEERE HEALTHCARE
TN4042447OtherBLUE CROSS BLUE SHIELD
TN3876134Medicaid
TN7749348OtherAETNA
TN100039411OtherTENNCARE
TN200046167OtherRAILROAD MEDICARE
3876135Medicare ID - Type Unspecified
TN103I201633Medicare PIN
H00548Medicare UPIN
TN100039411OtherTENNCARE
TN7749348OtherAETNA