Healthcare Provider Details

I. General information

NPI: 1679536544
Provider Name (Legal Business Name): STEVEN EDWARD SPENCER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 ROGER BROOKE DR
SAN ANTONIO TX
78234
US

IV. Provider business mailing address

306 E NOTTINGHAM DR
SAN ANTONIO TX
78209-3329
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-0942
  • Fax:
Mailing address:
  • Phone: 301-806-5537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number022009
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberMD218587
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: