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General NPI Number Information
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NPI Number | 1730529587
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Entity Type | Individual
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Provider Name | SPENCER SHIRK D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/26/2013
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Last Update Date | 08/02/2016
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Provider Practice Location Address
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Address Line | 100 BREWSTER BLVD NAVAL HOSPITAL
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City | CAMP LEJEUNE
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State | NC
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Zip | 28547-2538
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Country | US
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Telephone | 910-450-4159
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Fax | 910-450-4194
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Provider Business Mailing Address
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Address Line | 100 BREWSTER BLVD NAVAL HOSPITAL
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City | CAMP LEJEUNE
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State | NC
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Zip | 28547-2538
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Country | US
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Telephone | 910-450-4159
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Fax | 910-450-4194
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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 | OS017363
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License Number State | PA
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