Healthcare Provider Details

I. General information

NPI: 1578625828
Provider Name (Legal Business Name): GEOFFREY S SPENCER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 SAMARITAN DR SUITE #1
SAN JOSE CA
95124-3911
US

IV. Provider business mailing address

2440 SAMARITAN DR SUITE #1
SAN JOSE CA
95124-3911
US

V. Phone/Fax

Practice location:
  • Phone: 408-626-7375
  • Fax: 408-626-7368
Mailing address:
  • Phone: 408-626-7375
  • Fax: 408-626-7368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA108150
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD421763
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: