Provider Demographics
NPI:1902834153
Name:SPENCER, UPSHUR M (MD)
Entity Type:Individual
Prefix:DR
First Name:UPSHUR
Middle Name:M
Last Name:SPENCER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3831 PIPER ST
Mailing Address - Street 2:SUITE S-220
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4672
Mailing Address - Country:US
Mailing Address - Phone:907-563-3145
Mailing Address - Fax:907-561-3967
Practice Address - Street 1:3831 PIPER ST
Practice Address - Street 2:SUITE S-220
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4672
Practice Address - Country:US
Practice Address - Phone:907-563-3145
Practice Address - Fax:907-561-3967
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2780207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD62751Medicaid
AKMD62751Medicaid
160153Medicare ID - Type Unspecified