Healthcare Provider Details

I. General information

NPI: 1649295809
Provider Name (Legal Business Name): WESTON E. SPENCER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1912 W 930 N
PLEASANT GROVE UT
84062-4104
US

IV. Provider business mailing address

1912 W 930 N
PLEASANT GROVE UT
84062-4104
US

V. Phone/Fax

Practice location:
  • Phone: 801-492-1999
  • Fax: 801-922-9370
Mailing address:
  • Phone: 801-492-1999
  • Fax: 801-922-9370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2444562-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: