Healthcare Provider Details

I. General information

NPI: 1407760143
Provider Name (Legal Business Name): WILLIAM MARK SPENCE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: WILL MARK SPENCE PA-C

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S NEW BALLAS RD
SAINT LOUIS MO
63141-8221
US

IV. Provider business mailing address

747 RIVER GLEN DR
O FALLON MO
63368-9647
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6000
  • Fax:
Mailing address:
  • Phone: 636-486-5613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: