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NPI Code Detail

MEDICARE: JONATHAN M SPENCER

MEDICARE:   JONATHAN M 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
1372500000XChore Provider

General Provider Information

NPI Number : 1801234307
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN M SPENCER
Provider Business Mailing Address
First Line : 4523 SARATOGA PL
Second Line :
City : HUBER HEIGHTS
State : OH
Zip : 45424-3781
Country : US
Telephone Number : 937-823-3434
Fax Number : 937-242-6015
Provider Business Practice Location Address
First Line : 4523 SARATOGA PL
Second Line :
City : HUBER HEIGHTS
State : OH
Zip : 45424-3781
Country : US
Telephone Number : 937-823-3434
Fax Number : 937-242-6015
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2013
Last Update Date : 06/06/2013

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Directions to “ JONATHAN M SPENCER ” Practice Location

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