MEDICARE: CHARLES W SPENCER

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
1	237700000X	Hearing Instrument Specialist	HAD7386	AZ

General Provider Information

NPI Number	:	1336750207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES W SPENCER

Provider Business Mailing Address
First Line	:	1155 S POWER RD STE 109
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-3716
Country	:	US
Telephone Number	:	623-582-6699
Fax Number	:

Provider Business Practice Location Address
First Line	:	1155 S POWER RD STE 109
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-3716
Country	:	US
Telephone Number	:	623-582-6699
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2020
Last Update Date	:	08/13/2020

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