MEDICARE: THOMAS 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
1	207RP1001X	Pulmonary Disease Physician	R5H59	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	003013175	OTHER	MO	AREA 99 MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447221379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS SPENCE MD

Provider Business Mailing Address
First Line	:	3009 N BALLAS RD STE 315A
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-2324
Country	:	US
Telephone Number	:	314-996-4700
Fax Number	:

Provider Business Practice Location Address
First Line	:	3009 N BALLAS RD STE 315A
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-2324
Country	:	US
Telephone Number	:	314-996-4700
Fax Number	:

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	11/01/2021

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Directions to “ THOMAS SPENCE MD” Practice Location

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