Provider Demographics
NPI:1063241107
Name:BRAZIL, SPENCER
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:BRAZIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 HIGHWAY 216
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:AR
Mailing Address - Zip Code:72070-8249
Mailing Address - Country:US
Mailing Address - Phone:501-889-8481
Mailing Address - Fax:
Practice Address - Street 1:1125 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-1908
Practice Address - Country:US
Practice Address - Phone:501-686-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program