Provider Demographics
NPI:1578669149
Name:SPENCER, CORY DORAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:DORAN
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 1:2280 HARRISON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3200
Mailing Address - Country:US
Mailing Address - Phone:707-443-9371
Mailing Address - Fax:
Practice Address - Street 1:2280 HARRISON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3200
Practice Address - Country:US
Practice Address - Phone:707-443-9371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71456207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G714560Medicaid
CA00G714560Medicaid
CA00G714561Medicare PIN