Provider Demographics
NPI:1578553145
Name:SPENCER, JAMES CRUEY (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CRUEY
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 1:1739 E BEVERLY AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3593
Mailing Address - Country:US
Mailing Address - Phone:928-692-3456
Mailing Address - Fax:928-692-7071
Practice Address - Street 1:1739 E BEVERLY AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3593
Practice Address - Country:US
Practice Address - Phone:928-692-3456
Practice Address - Fax:928-692-7071
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ27918207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ211889Medicaid
AZ27918OtherLICENSE
AZBS3922146OtherDEA
AZBS3922146OtherDEA
AZF72564Medicare UPIN