Healthcare Provider Details

I. General information

NPI: 1548369937
Provider Name (Legal Business Name): JOHN SPENCER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15920 S RANCHO SAHUARITA BLVD STE 120
SAHUARITA AZ
85629-8013
US

IV. Provider business mailing address

15920 S RANCHO SAHUARITA BLVD STE 120
SAHUARITA AZ
85629-8013
US

V. Phone/Fax

Practice location:
  • Phone: 520-575-1175
  • Fax:
Mailing address:
  • Phone: 520-575-1175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00024816
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number46503
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: