Provider Demographics
NPI:1881165470
Name:MARSDEN, SPENCER JOSEPH (PA-C)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:JOSEPH
Last Name:MARSDEN
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 1:1441 NE 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:PAYETTE
Mailing Address - State:ID
Mailing Address - Zip Code:83661-5420
Mailing Address - Country:US
Mailing Address - Phone:208-642-9376
Mailing Address - Fax:208-642-9598
Practice Address - Street 1:17 N 6TH ST
Practice Address - Street 2:
Practice Address - City:NYSSA
Practice Address - State:OR
Practice Address - Zip Code:97913-3477
Practice Address - Country:US
Practice Address - Phone:541-372-2606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-08
Last Update Date:2019-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA191063363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant