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General NPI Number Information
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NPI Number | 1629161823
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Entity Type | Organization
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Legal Business Name | ROBERT G. SPENCER MD PLLC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 12/20/2011
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Provider Practice Location Address
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Address Line | 203 N WEIGLE AVE
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City | WATONGA
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State | OK
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Zip | 73772-3840
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Country | US
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Telephone | 580-623-2233
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Fax | 580-623-2232
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Provider Business Mailing Address
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Address Line | PO BOX 60
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City | WATONGA
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State | OK
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Zip | 73772-0060
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Country | US
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Telephone | 580-623-2233
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Fax | 580-623-2232
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT GORDON SPENCER
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Credential | MD
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Telephone | 580-623-2233
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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 | 23186
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License Number State | OK
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