Provider Demographics
NPI:1629055678
Name:CARLSTONE, SPENCER L (MD)
Entity type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:L
Last Name:CARLSTONE
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 1:1518 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-7580
Mailing Address - Country:US
Mailing Address - Phone:641-255-2688
Mailing Address - Fax:641-767-3103
Practice Address - Street 1:1518 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-7580
Practice Address - Country:US
Practice Address - Phone:641-255-2688
Practice Address - Fax:641-767-3103
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0031207Q00000X
ARE4698207Q00000X
IA36471207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3490896Medicaid
IA0490896Medicaid
IA1490896Medicaid
IA2490896Medicaid
TX171434701Medicaid
IA4490896Medicaid
IA2490896Medicaid
IA0490896Medicaid
IAI17619Medicare PIN