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NPI Code Detail

MEDICARE: JOHN H SPENCER PA

MEDICARE: JOHN H SPENCER PA
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
1363AM0700XMedical Physician Assistant102279NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1197929OTHERNCMEDCOST
27297655OTHERNCAETNA ID

General Provider Information

NPI Number : 1972505840
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN H SPENCER PA
Provider Business Mailing Address
First Line : PO BOX 7867
Second Line :
City : ROCKY MOUNT
State : NC
Zip : 27804-0867
Country : US
Telephone Number : 252-451-2700
Fax Number : 252-451-2702
Provider Business Practice Location Address
First Line : 1041 NOELL LN
Second Line : SUITE 105
City : ROCKY MOUNT
State : NC
Zip : 27804-2058
Country : US
Telephone Number : 252-451-2700
Fax Number : 252-451-2702
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2005
Last Update Date : 04/25/2014

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Directions to “ JOHN H SPENCER PA” Practice Location

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