Healthcare Provider Details

I. General information

NPI: 1427552561
Provider Name (Legal Business Name): DEAN SPENCER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 LILLY RD NE STE 200
OLYMPIA WA
98506-5101
US

IV. Provider business mailing address

525 LILLY RD NE STE 200
OLYMPIA WA
98506-5101
US

V. Phone/Fax

Practice location:
  • Phone: 360-493-4510
  • Fax: 360-493-7759
Mailing address:
  • Phone: 360-493-4510
  • Fax: 360-493-7759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD.MD.70097829
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: