Provider Demographics
NPI:1831285089
Name:SPENCER, DONNIE R (MD)
Entity Type:Individual
Prefix:
First Name:DONNIE
Middle Name:R
Last Name:SPENCER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:870 CORPORATE DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-5416
Mailing Address - Country:US
Mailing Address - Phone:859-277-9436
Mailing Address - Fax:859-977-0092
Practice Address - Street 1:1032 DAWAHARE DR
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-8937
Practice Address - Country:US
Practice Address - Phone:606-439-3311
Practice Address - Fax:606-436-5155
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2010-03-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY18056207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY406012621OtherRAIL ROAD MEDICARE
KY64180565Medicaid
KY64180565Medicaid
KYC69862Medicare UPIN