Healthcare Provider Details

I. General information

NPI: 1104864388
Provider Name (Legal Business Name): SCOTT EDWARD SPENCER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SCOTT E SPENCER MD

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 E 29TH ST 260
BRYAN TX
77802-2587
US

IV. Provider business mailing address

2700 E 29TH ST STE 260
BRYAN TX
77802-2587
US

V. Phone/Fax

Practice location:
  • Phone: 979-774-0012
  • Fax: 979-774-4636
Mailing address:
  • Phone: 979-774-0012
  • Fax: 979-774-4636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberL1758
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberL1758
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: