Provider Demographics
NPI:1306257688
Name:SPENCER, MARIA C (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:C
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:C
Other - Last Name:MALDONADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 23229
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-3229
Mailing Address - Country:US
Mailing Address - Phone:270-691-8070
Mailing Address - Fax:270-691-8026
Practice Address - Street 1:775 1ST AVE N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6005
Practice Address - Country:US
Practice Address - Phone:392-623-3992
Practice Address - Fax:239-261-1189
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2023-04-26
Deactivation Date:2014-12-10
Deactivation Code:
Reactivation Date:2015-04-23
Provider Licenses
StateLicense IDTaxonomies
MI4301105750207V00000X
KY51590207V00000X
390200000X
FLME157760207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100566340Medicaid