Provider Demographics
NPI:1770589004
Name:SPENCER, SCOTT ALAN (DPM)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALAN
Last Name:SPENCER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 ROCKSIDE WOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2330
Mailing Address - Country:US
Mailing Address - Phone:216-231-3300
Mailing Address - Fax:
Practice Address - Street 1:7000 EUCLID AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-4014
Practice Address - Country:US
Practice Address - Phone:216-231-5612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-2444-S213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCI 5538OtherRR MEDICARE GROUP BFAC
OH0935322Medicaid
OH480017770OtherRR MEDICARE BFAC
OHCH 5179OtherRR MEDICARE GROUP CFAC
OH480031326OtherRAIL ROAD MEDICARE
OH9247011 GROUP BFACMedicare UPIN
OH1131510004Medicare NSC
OHT80633Medicare UPIN
OH0616264Medicare PIN
OH0935322Medicaid
OH480031326OtherRAIL ROAD MEDICARE
OH4310000001Medicare NSC
OH9312431 GROUP CFACMedicare PIN