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General NPI Number Information
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NPI Number | 1497719728
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Entity Type | Individual
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Provider Name | MARK D SPENCER MD
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Gender | Male
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Dates
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Enumeration Date | 04/13/2006
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 410 N IDAHO ST
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City | WENDELL
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State | ID
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Zip | 83355-5038
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Country | US
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Telephone | 208-990-3226
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Fax | 888-440-7959
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Provider Business Mailing Address
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Address Line | PO BOX 447
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City | GOODING
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State | ID
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Zip | 83330
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Country | US
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Telephone | 208-934-5900
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Fax | 208-934-5719
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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 | M4484
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License Number State | ID
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