Healthcare Provider Details

I. General information

NPI: 1871698852
Provider Name (Legal Business Name): SARAH C SPENCER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 01/08/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15765 KINSLEY RD
NINILCHIK AK
99639
US

IV. Provider business mailing address

PO BOX 39386
NINILCHIK AK
99639-0386
US

V. Phone/Fax

Practice location:
  • Phone: 907-567-3970
  • Fax: 907-567-3902
Mailing address:
  • Phone: 907-567-3970
  • Fax: 907-567-3902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberT0864
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6673
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMEDO6673
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: