Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | D14265 | MD |
N | 208600000X | Surgeon | D14265 | MD |
N | 2086S0122X | Plastic and Reconstructive Surgery | D14265 | MD |
NPI | 1174675672 |
---|---|
Provider Name | Robert J Spence |
First Address | Baltimore, MD 21264-4563 |
Second Address | Baltimore, MD 21224-2735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D74452 | (02) | MD |