Healthcare Provider Details

I. General information

NPI: 1528030251
Provider Name (Legal Business Name): TIMOTHY A SPENCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 03/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E CHEVES ST
FLORENCE SC
29506-2604
US

IV. Provider business mailing address

PO BOX 3239
FLORENCE SC
29502-3239
US

V. Phone/Fax

Practice location:
  • Phone: 843-777-7603
  • Fax: 843-662-2474
Mailing address:
  • Phone: 843-777-7603
  • Fax: 843-662-2474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17446
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: