Provider Demographics
NPI:1821017120
Name:SPENCER, SHARON
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1717 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1801
Practice Address - Country:US
Practice Address - Phone:800-822-8816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL118252085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000016550Medicaid
AL009981870Medicaid
AL000036293OtherBLUE CROSS
ALC76299OtherVIVA
AL000016550OtherBLUE CROSS
AL000036293Medicaid
AL051501620OtherBLUE CROSS
AL051506010OtherBLUE CROSS
AL051513419OtherBLUE CROSS
AL009911113Medicaid
AL051539001OtherBLUE CROSS
AL051501620OtherBLUE CROSS
AL051539001OtherBLUE CROSS