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General NPI Number Information
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NPI Number | 1780889477
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Entity Type | Individual
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Provider Name | SPENCER WADE TOWNSEND P.A.
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Gender | Male
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 1551 BISHOP ST BLDG B STE 220
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-4661
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Country | US
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Telephone | 805-543-2744
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Fax | 805-543-0539
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Provider Business Mailing Address
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Address Line | PO BOX 603725
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City | CHARLOTTE
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State | NC
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Zip | 28260-3725
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Country | US
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Telephone | 828-575-2625
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Fax | 828-350-2174
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA19181
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 19181
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License Number State | CA
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