Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 036-048992 | IL |
NPI | 1275678716 |
---|---|
Provider Name | Dr. David Spencer |
First Address | Park Ridge, IL 60068-1186 |
Second Address | Park Ridge, IL 60068-1186 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 22/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1952307092 | NPI (01) | IL |
D13479 | (02) | IL |