Provider Demographics
NPI:1104946847
Name:HEATON, SPENCER (MD)
Entity type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:
Last Name:HEATON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:680 E MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2241
Mailing Address - Country:US
Mailing Address - Phone:801-768-2755
Mailing Address - Fax:801-768-2658
Practice Address - Street 1:680 E MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2241
Practice Address - Country:US
Practice Address - Phone:801-768-2755
Practice Address - Fax:801-768-2658
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8447939-1205207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine