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General NPI Number Information
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NPI Number | 1770589004
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Entity Type | Individual
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Provider Name | SCOTT ALAN SPENCER D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 02/28/2013
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Provider Practice Location Address
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Address Line | 7000 EUCLID AVE SUITE 101
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City | CLEVELAND
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State | OH
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Zip | 44103-4014
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Country | US
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Telephone | 216-231-5612
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Fax |
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Provider Business Mailing Address
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Address Line | 6000 ROCKSIDE WOODS BLVD
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City | INDEPENDENCE
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State | OH
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Zip | 44131-2330
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Country | US
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Telephone | 216-231-3300
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 36-00-2444-S
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License Number State | OH
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