Provider Demographics
NPI:1588669956
Name:SPENCE, DAVID LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
Last Name:SPENCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:501 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-8124
Mailing Address - Country:US
Mailing Address - Phone:318-442-5800
Mailing Address - Fax:318-442-1109
Practice Address - Street 1:501 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 4A
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8124
Practice Address - Country:US
Practice Address - Phone:318-442-5800
Practice Address - Fax:318-442-1109
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA06921R207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1397938Medicaid
LASM797Medicare ID - Type Unspecified
D42850Medicare UPIN