Provider Demographics
NPI:1720011430
Name:SPENCER, GRACIELA PATRICIA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:GRACIELA
Middle Name:PATRICIA
Last Name:SPENCER
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1483 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5165
Mailing Address - Country:US
Mailing Address - Phone:830-560-2813
Mailing Address - Fax:830-560-2812
Practice Address - Street 1:1483 E COURT ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5165
Practice Address - Country:US
Practice Address - Phone:830-560-2813
Practice Address - Fax:830-560-2812
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04969363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L25569Medicare PIN
TXQ78268Medicare UPIN