Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 01025454A | IN |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 01025454A | IN |
NPI | 1740381748 |
---|---|
Provider Name | Dr. William Craig Spence |
First Address | Bloomington, IN 47403-2353 |
Second Address | Bloomington, IN 47403-2353 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 05/10/2016 |