Provider Demographics
NPI:1659332542
Name:SPENCER, JEFFREY CLARK (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:CLARK
Last Name:SPENCER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:809 COSHOCTON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-1900
Mailing Address - Country:US
Mailing Address - Phone:740-397-7550
Mailing Address - Fax:740-397-7640
Practice Address - Street 1:14730 FRED AMITY RD
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:OH
Practice Address - Zip Code:43019-9776
Practice Address - Country:US
Practice Address - Phone:740-694-1343
Practice Address - Fax:740-694-1369
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35040551204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA76177Medicare UPIN
OH0435076Medicare PIN