Provider Demographics
NPI:1750441440
Name:SPENCE, DALE A (PA-C)
Entity type:Individual
Prefix:MR
First Name:DALE
Middle Name:A
Last Name:SPENCE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EVANS ARMY COMUNITY HOSPITAL (EACH) USA
Mailing Address - Street 2:1650 COCHRANE CIR ATTN CREDENTIALS OFFICE
Mailing Address - City:FT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4604
Mailing Address - Country:US
Mailing Address - Phone:719-526-7844
Mailing Address - Fax:719-526-7984
Practice Address - Street 1:EVANS ARMY COMUNITY HOSPITAL
Practice Address - Street 2:PREMIER MEDICAL HOME
Practice Address - City:FT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4604
Practice Address - Country:US
Practice Address - Phone:719-524-7601
Practice Address - Fax:719-524-3526
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01722363A00000X
CO2430363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant