Provider Demographics
NPI:1821231986
Name:SPENCE, NATHAN EMIL (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:EMIL
Last Name:SPENCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 KOOTENAI HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6051
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:208-625-5731
Practice Address - Street 1:122 W 7TH AVE STE 310
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2352
Practice Address - Country:US
Practice Address - Phone:509-847-2500
Practice Address - Fax:509-847-2501
Is Sole Proprietor?:No
Enumeration Date:2009-04-19
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMD60642429207RC0000X
WAMD.60642429207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease