Healthcare Provider Details

I. General information

NPI: 1417155391
Provider Name (Legal Business Name): SCOTT SIMNER SPENCER M.D, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 04/30/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 NW VAUGHN ST. SUITE 360
PORTLAN OR
97210
US

IV. Provider business mailing address

1510 DIVISION ST., STE. 280
OREGON CITY OR
97045
US

V. Phone/Fax

Practice location:
  • Phone: 503-227-0671
  • Fax: 503-227-0676
Mailing address:
  • Phone: 503-905-3400
  • Fax: 503-905-3399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4811
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD158012
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: