Healthcare Provider Details

I. General information

NPI: 1861753030
Provider Name (Legal Business Name): SPENCER GREY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 819 BOX 45
FPO AE
09645-0001
US

IV. Provider business mailing address

PO BOX 48
OQUOSSOC ME
04964-0048
US

V. Phone/Fax

Practice location:
  • Phone: 314-727-2895
  • Fax:
Mailing address:
  • Phone: 703-232-2733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: