Healthcare Provider Details

I. General information

NPI: 1356369938
Provider Name (Legal Business Name): STEVEN J SPENCER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8211 W 3500 SO
MAGNA UT
84044
US

IV. Provider business mailing address

8211 W 3500 SO
MAGNA UT
84044
US

V. Phone/Fax

Practice location:
  • Phone: 801-250-9638
  • Fax: 801-250-3204
Mailing address:
  • Phone: 801-250-9638
  • Fax: 801-250-3204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3624141205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: