Healthcare Provider Details

I. General information

NPI: 1770589004
Provider Name (Legal Business Name): SCOTT ALAN SPENCER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 EUCLID AVE SUITE 101
CLEVELAND OH
44103-4014
US

IV. Provider business mailing address

6000 ROCKSIDE WOODS BLVD
INDEPENDENCE OH
44131-2330
US

V. Phone/Fax

Practice location:
  • Phone: 216-231-5612
  • Fax:
Mailing address:
  • Phone: 216-231-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36-00-2444-S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: