Provider Demographics
NPI:1578625828
Name:SPENCER, GEOFFREY S (MD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:S
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 1:2440 SAMARITAN DR
Mailing Address - Street 2:SUITE #1
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-3911
Mailing Address - Country:US
Mailing Address - Phone:408-626-7375
Mailing Address - Fax:408-626-7368
Practice Address - Street 1:2440 SAMARITAN DR
Practice Address - Street 2:SUITE #1
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3911
Practice Address - Country:US
Practice Address - Phone:408-626-7375
Practice Address - Fax:408-626-7368
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA108150207RG0100X
PAMD421763207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology