MEDICARE: DR. CRAIG WILLIAM SPENNER SR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	R1A88	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	070001348	OTHER	MO	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1154320877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG WILLIAM SPENNER SR. MD

Provider Business Mailing Address
First Line	:	439 S KIRKWOOD RD
Second Line	:	SIUTE 206
City	:	KIRKWOOD
State	:	MO
Zip	:	63122-6169
Country	:	US
Telephone Number	:	314-966-2010
Fax Number	:	314-966-4825

Provider Business Practice Location Address
First Line	:	439 S KIRKWOOD RD
Second Line	:	SIUTE 206
City	:	KIRKWOOD
State	:	MO
Zip	:	63122-6169
Country	:	US
Telephone Number	:	314-966-2010
Fax Number	:	314-966-4825

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	05/13/2008

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