Provider Demographics
NPI:1619300993
Name:SPENCER, RALPH KEVIN
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:KEVIN
Last Name:SPENCER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 YANKEE CLIPPER DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-3510
Mailing Address - Country:US
Mailing Address - Phone:702-712-8558
Mailing Address - Fax:702-272-2303
Practice Address - Street 1:3025 YANKEE CLIPPER DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-3510
Practice Address - Country:US
Practice Address - Phone:702-712-8558
Practice Address - Fax:702-272-2303
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator