Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 22222 | MS |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 22222 | MS |
NPI | 1730395542 |
---|---|
Provider Name | David D Spence |
First Address | Germantown, TN 38138-2205 |
Second Address | Southaven, MS 38671-5806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 01/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05502928 | (05) | MS |
1529784 | (05) | TN |
195169001 | (05) | AR |