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General NPI Number Information
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NPI Number | 1154775468
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Entity Type | Individual
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Provider Name | LUKE SPENCER
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Gender | Male
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Dates
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Enumeration Date | 04/22/2016
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 3020 BONBROOK DR
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City | WINSTON SALEM
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State | NC
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Zip | 27106-3020
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Country | US
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Telephone | 336-713-5393
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Fax | 336-716-5334
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Provider Business Mailing Address
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Address Line | 105 BRAMPTON CT
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City | WINSTON SALEM
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State | NC
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Zip | 27106-4482
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Country | US
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Telephone |
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2019-01725
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License Number State | NC
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