Provider Demographics
NPI:1578877395
Name:SPENNER DERMATOLOGY INC
Entity Type:Organization
Organization Name:SPENNER DERMATOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SPENNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-966-2010
Mailing Address - Street 1:439 S KIRKWOOD RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-6169
Mailing Address - Country:US
Mailing Address - Phone:314-966-2010
Mailing Address - Fax:314-966-4825
Practice Address - Street 1:439 S KIRKWOOD RD
Practice Address - Street 2:SUITE 206
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-6169
Practice Address - Country:US
Practice Address - Phone:314-966-2010
Practice Address - Fax:314-966-4825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-04
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1A88207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1154320877OtherCRAIG SPENNER M.D.
MO1154320877OtherTYPE 1 NPI
MOA09941Medicare UPIN
MO1154320877OtherTYPE 1 NPI