Provider Demographics
NPI:1689826919
Name:THOMAS S SPENCER MD PC
Entity Type:Organization
Organization Name:THOMAS S SPENCER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-425-2474
Mailing Address - Street 1:PO BOX 3955
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-2610
Mailing Address - Country:US
Mailing Address - Phone:928-425-2474
Mailing Address - Fax:928-425-2383
Practice Address - Street 1:703 E ASH ST
Practice Address - Street 2:STE # 1B
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-1865
Practice Address - Country:US
Practice Address - Phone:928-425-2474
Practice Address - Fax:928-425-2383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-17
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41026207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H81071Medicare UPIN
241290AMedicare PIN