Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | M10519 | ID |
N | 208800000X | Urologist | MD00044961 | WA |
NPI | 1033186606 |
---|---|
Provider Name | Craig R Spencer |
First Address | Boise, ID 83712-6241 |
Second Address | Meridian, ID 83642-6351 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2006 |
Last Update Date | 18/09/2012 |