Provider Demographics
NPI:1801234307
Name:SPENCER, JONATHAN M
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:M
Last Name:SPENCER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4523 SARATOGA PL
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-3781
Mailing Address - Country:US
Mailing Address - Phone:937-823-3434
Mailing Address - Fax:937-242-6015
Practice Address - Street 1:4523 SARATOGA PL
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-3781
Practice Address - Country:US
Practice Address - Phone:937-823-3434
Practice Address - Fax:937-242-6015
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider