Healthcare Provider Details

I. General information

NPI: 1346252855
Provider Name (Legal Business Name): ROBERT SPENCER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 MAIN STREET CALDWELL CLINIC
CALDWELL OH
43724-1396
US

IV. Provider business mailing address

47871 SENECA LAKE RD
SARAHSVILLE OH
43779-9794
US

V. Phone/Fax

Practice location:
  • Phone: 740-732-2339
  • Fax: 740-732-2350
Mailing address:
  • Phone: 740-525-0422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34-00-4380
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: