MEDICARE: MR. RALPH KEVIN SPENCER

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	174H00000X	Health Educator

General Provider Information

NPI Number	:	1619300993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RALPH KEVIN SPENCER

Provider Business Mailing Address
First Line	:	3025 YANKEE CLIPPER DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-3510
Country	:	US
Telephone Number	:	702-712-8558
Fax Number	:	702-272-2303

Provider Business Practice Location Address
First Line	:	3025 YANKEE CLIPPER DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-3510
Country	:	US
Telephone Number	:	702-712-8558
Fax Number	:	702-272-2303

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

Provider Enumeration Date	:	08/09/2013
Last Update Date	:	08/09/2013

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Directions to “ MR. RALPH KEVIN SPENCER ” Practice Location

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