MEDICARE: ROBERT JAMES SPENSLEY 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	2084P0800X	Psychiatry Physician	C30158	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C30158	OTHER	CA	MD

General Provider Information

NPI Number	:	1649270802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT JAMES SPENSLEY MD

Provider Business Mailing Address
First Line	:	4217 WINDING WOODS WAY
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-6446
Country	:	US
Telephone Number	:	916-704-1015
Fax Number	:

Provider Business Practice Location Address
First Line	:	4217 WINDING WOODS WAY
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-6446
Country	:	US
Telephone Number	:	916-704-1015
Fax Number	:

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	09/21/2015

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