MEDICARE: SPENCER ROBERT ANDERSON 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	208200000X	Plastic Surgery Physician	95455	GA
2	208200000X	Plastic Surgery Physician	35.154811	OH

General Provider Information

NPI Number	:	1982139176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SPENCER ROBERT ANDERSON M.D.

Provider Business Mailing Address
First Line	:	580 LINCOLN PARK BLVD STE 225
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-3493
Country	:	US
Telephone Number	:	937-949-8457
Fax Number	:	937-949-8695

Provider Business Practice Location Address
First Line	:	580 LINCOLN PARK BLVD STE 225
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-3493
Country	:	US
Telephone Number	:	937-949-8457
Fax Number	:	937-949-8695

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

Provider Enumeration Date	:	04/25/2017
Last Update Date	:	01/13/2026

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