Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | DP190571 | OR |
N | 213ES0131X | Foot Surgery | DP190571 | OR |
NPI | 1619394061 |
---|---|
Provider Name | Dr. Jarod Spencer |
First Address | Salem, OR 97306-9427 |
Second Address | Salem, OR 97306-9427 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2014 |
Last Update Date | 04/02/2022 |