Healthcare Provider Details

I. General information

NPI: 1063495877
Provider Name (Legal Business Name): JAMES D SPENCER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 E ELM ST
CARSON CITY MI
48811-9693
US

IV. Provider business mailing address

406 E ELM ST
CARSON CITY MI
48811-9693
US

V. Phone/Fax

Practice location:
  • Phone: 989-584-6139
  • Fax: 989-584-2541
Mailing address:
  • Phone: 989-584-6139
  • Fax: 989-584-2541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5101009107
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: