MEDICARE: DR. ROY EDWARD SPENCER 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	D2601	TX

General Provider Information

NPI Number	:	1568760916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROY EDWARD SPENCER MD

Provider Business Mailing Address
First Line	:	601 ANSLEY LANE
Second Line	:
City	:	DENISON
State	:	TX
Zip	:	75020
Country	:	US
Telephone Number	:	903-465-2440
Fax Number	:	903-465-2298

Provider Business Practice Location Address
First Line	:	900 NORTH ARMSTRONG
Second Line	:
City	:	DENISON
State	:	TX
Zip	:	75020
Country	:	US
Telephone Number	:	903-465-2440
Fax Number	:	903-465-2298

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

Provider Enumeration Date	:	03/09/2011
Last Update Date	:	03/09/2011

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