Provider Demographics
NPI:1841323144
Name:PATRICK A SPENSLEY MD PC
Entity type:Organization
Organization Name:PATRICK A SPENSLEY MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPENSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-538-0411
Mailing Address - Street 1:2318 PORTLAND RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-1372
Mailing Address - Country:US
Mailing Address - Phone:503-538-0411
Mailing Address - Fax:503-538-1650
Practice Address - Street 1:2318 PORTLAND RD
Practice Address - Street 2:SUITE 300
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1372
Practice Address - Country:US
Practice Address - Phone:503-538-0411
Practice Address - Fax:503-538-1650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19698207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR130905Medicare PIN