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NPI Code Detail

MEDICARE: SHANNA LEIGH SPENCE MD

MEDICARE: SHANNA LEIGH SPENCE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianC8442AR
2207Q00000XFamily Medicine PhysicianK1075TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18B4912OTHERTRALBLAZERS

General Provider Information

NPI Number : 1255338943
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNA LEIGH SPENCE MD
Provider Business Mailing Address
First Line : 300 E 6TH ST
Second Line :
City : TEXARKANA
State : AR
Zip : 71854-5207
Country : US
Telephone Number : 870-779-6004
Fax Number : 870-779-6100
Provider Business Practice Location Address
First Line : 300 E 6TH ST
Second Line :
City : TEXARKANA
State : AR
Zip : 71854-5207
Country : US
Telephone Number : 870-779-6004
Fax Number : 870-779-6100
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 08/22/2007

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Directions to “ SHANNA LEIGH SPENCE MD” Practice Location

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