Provider Demographics
NPI:1851414684
Name:SU, SPENCER HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:HENRY
Last Name:SU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7500 BEECHNUT ST
Mailing Address - Street 2:STE 262
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-4311
Mailing Address - Country:US
Mailing Address - Phone:713-790-4615
Mailing Address - Fax:713-790-5878
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:SUITE 2206
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2761
Practice Address - Country:US
Practice Address - Phone:713-790-4615
Practice Address - Fax:713-790-5878
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2020-02-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM5944207R00000X, 207RN0300X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB155862Medicare PIN