Healthcare Provider Details

I. General information

NPI: 1710969415
Provider Name (Legal Business Name): TIMOTHY AARON SPENCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12221 N MOPAC EXPY
AUSTIN TX
78758-2401
US

IV. Provider business mailing address

7800 SHOAL CREEK BLVD SUITE 205N
AUSTIN TX
78757-1098
US

V. Phone/Fax

Practice location:
  • Phone: 737-247-7200
  • Fax: 512-406-7368
Mailing address:
  • Phone: 915-542-2352
  • Fax: 512-406-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00049218
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number00025763
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP2534
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberP2534
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: