Provider Demographics
NPI:1861650947
Name:SPENCER, BRENT AUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:AUSTIN
Last Name:SPENCER
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 1:3535 VICTORY GROUP WAY
Mailing Address - Street 2:STE 200
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6721
Mailing Address - Country:US
Mailing Address - Phone:972-712-5100
Mailing Address - Fax:972-712-5113
Practice Address - Street 1:3535 VICTORY GROUP WAY
Practice Address - Street 2:STE 200
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-6721
Practice Address - Country:US
Practice Address - Phone:972-712-5100
Practice Address - Fax:972-712-5113
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8356207NS0135X, 207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CC921OtherBCBSTX INDIVIDUAL ID
TX8F22353Medicare PIN