Healthcare Provider Details

I. General information

NPI: 1487501896
Provider Name (Legal Business Name): SPENCER DOUGLAS ANDERSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 VALLEY RD STE 210
LINCOLN NE
68510-4892
US

IV. Provider business mailing address

4600 VALLEY RD STE 210
LINCOLN NE
68510-4892
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-4591
  • Fax: 402-483-5079
Mailing address:
  • Phone: 402-483-4591
  • Fax: 402-483-5079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1487501896
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: