Provider Demographics
NPI:1194721381
Name:SPENCER, MARY J (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:J
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:910 E OHIO AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3439
Mailing Address - Country:US
Mailing Address - Phone:760-745-7313
Mailing Address - Fax:760-745-6360
Practice Address - Street 1:910 E OHIO AVE
Practice Address - Street 2:STE 103
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3439
Practice Address - Country:US
Practice Address - Phone:760-745-7313
Practice Address - Fax:760-745-6360
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG11119208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA90116Medicare UPIN