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General NPI Number Information
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NPI Number | 1154320877
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Entity Type | Individual
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Provider Name | CRAIG WILLIAM SPENNER SR. MD
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Gender | Male
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Dates
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Enumeration Date | 07/14/2005
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Last Update Date | 05/13/2008
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Provider Practice Location Address
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Address Line | 439 S KIRKWOOD RD SIUTE 206
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City | KIRKWOOD
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State | MO
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Zip | 63122-6169
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Country | US
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Telephone | 314-966-2010
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Fax | 314-966-4825
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Provider Business Mailing Address
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Address Line | 439 S KIRKWOOD RD SIUTE 206
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City | KIRKWOOD
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State | MO
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Zip | 63122-6169
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Country | US
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Telephone | 314-966-2010
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Fax | 314-966-4825
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | R1A88
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License Number State | MO
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