Healthcare Provider Details

I. General information

NPI: 1063440824
Provider Name (Legal Business Name): THOMAS RICHMOND SPENCER PHD PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 EAST GOVERNMENT STREET
PENSACOLA FL
32502
US

IV. Provider business mailing address

600 EAST GOVERNMENT STREET
PENSACOLA FL
32502
US

V. Phone/Fax

Practice location:
  • Phone: 850-434-5033
  • Fax: 850-433-0268
Mailing address:
  • Phone: 850-434-5033
  • Fax: 850-433-0268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY4097
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: