Healthcare Provider Details

I. General information

NPI: 1376694281
Provider Name (Legal Business Name): RANDALL BURL SPENCER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 GREAT OAKS BLVD
SAN JOSE CA
95119-1314
US

IV. Provider business mailing address

18583 DECATUR RD
LOS GATOS CA
95030-3086
US

V. Phone/Fax

Practice location:
  • Phone: 408-281-0708
  • Fax:
Mailing address:
  • Phone: 408-354-0958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA232980
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: