Provider Demographics
NPI:1205075223
Name:SPENCER, EDWARD LEE (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LEE
Last Name:SPENCER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:450 N BEDFORD DR STE 309
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4307
Mailing Address - Country:US
Mailing Address - Phone:310-425-3820
Mailing Address - Fax:855-729-4884
Practice Address - Street 1:450 N BEDFORD DR STE 309
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4307
Practice Address - Country:US
Practice Address - Phone:310-425-3820
Practice Address - Fax:855-729-4884
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-14
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT796732084P0800X
CAA1067292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFB940ZMedicare UPIN