Provider Demographics
NPI:1912960220
Name:SPENCER, JUDY (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6027 WALNUT GROVE RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2145
Mailing Address - Country:US
Mailing Address - Phone:901-681-0346
Mailing Address - Fax:901-682-7737
Practice Address - Street 1:6027 WALNUT GROVE RD
Practice Address - Street 2:SUITE 307
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2145
Practice Address - Country:US
Practice Address - Phone:901-681-0346
Practice Address - Fax:901-682-7737
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11723207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3198416Medicaid
MS14589Medicaid
TN3198416Medicaid
3198417Medicare ID - Type Unspecified