MEDICARE: DR. JEAN B SPENCER M.D.

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	207W00000X	Ophthalmology Physician	23328	IA

General Provider Information

NPI Number	:	1902801020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEAN B SPENCER M.D.

Provider Business Mailing Address
First Line	:	309 E CHURCH ST
Second Line	:
City	:	MARSHALLTOWN
State	:	IA
Zip	:	50158-2946
Country	:	US
Telephone Number	:	641-754-6200
Fax Number	:	641-754-6245

Provider Business Practice Location Address
First Line	:	6000 UNIVERSITY AVE
Second Line	:	STE 210
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-8203
Country	:	US
Telephone Number	:	515-222-1180
Fax Number	:	515-222-9635

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	07/01/2019

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