Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | 37260 | AZ |
N | 207YS0123X | Facial Plastic Surgeon | A95600 | CA |
Y | 207YS0123X | Facial Plastic Surgeon | E6045 | AR |
NPI | 1548465834 |
---|---|
Provider Name | Jared R Spencer |
First Address | Springdale, AR 72762 |
Second Address | Springdale, AR 72762 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2007 |
Last Update Date | 12/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
179309001 | (05) | AR |