Provider Demographics
NPI:1588649941
Name:SPENCER, BILL LARUE (CRNA)
Entity Type:Individual
Prefix:
First Name:BILL
Middle Name:LARUE
Last Name:SPENCER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18626 COUNTY ROAD 1550
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-3185
Mailing Address - Country:US
Mailing Address - Phone:580-436-0187
Mailing Address - Fax:
Practice Address - Street 1:18626 COUNTY ROAD 1550
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-3185
Practice Address - Country:US
Practice Address - Phone:580-436-0187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23309367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered