Provider Demographics
NPI:1184250334
Name:SPENCER, CAMERON (CNIM)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:SPENCER
Suffix:
Gender:M
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5080 SPECTRUM DR
Mailing Address - Street 2:STE 1100
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4648
Mailing Address - Country:US
Mailing Address - Phone:844-676-9374
Mailing Address - Fax:
Practice Address - Street 1:5080 SPECTRUM DR
Practice Address - Street 2:STE 1100
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4648
Practice Address - Country:US
Practice Address - Phone:844-676-9374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
4563246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic