Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 019-032602 | IL |
N | 1223G0001X | General Practice | 019-032602 | IL |
N | 213EG0000X | General Practice | 019-032602 | IL |
NPI | 1306460845 |
---|---|
Provider Name | Dr. Daniel Emerson Spencer |
First Address | Frankfort, IL 60423-1009 |
Second Address | Quincy, IL 62301-2700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2020 |
Last Update Date | 22/07/2020 |