Provider Demographics
NPI:1215951033
Name:SPENCER, BRIAN PATRICK (DPM)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:PATRICK
Last Name:SPENCER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 NORTH BROAD STREET
Mailing Address - Street 2:EXT. #2
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-5808
Mailing Address - Country:US
Mailing Address - Phone:724-450-1144
Mailing Address - Fax:724-450-1140
Practice Address - Street 1:675 NORTH BROAD STREET
Practice Address - Street 2:EXT. #2
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-5808
Practice Address - Country:US
Practice Address - Phone:724-450-1144
Practice Address - Fax:724-450-1140
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-004663-L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA065879Medicare ID - Type Unspecified
PAU93321Medicare UPIN