Provider Demographics
NPI:1316953672
Name:SPENCER, CHRISTOPHER C (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:C
Last Name:SPENCER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 SETON CENTER PKWY
Mailing Address - Street 2:SUITE 215
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5290
Mailing Address - Country:US
Mailing Address - Phone:512-231-5506
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:801 E WHITESTONE BLVD
Practice Address - Street 2:BLDG C
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-5028
Practice Address - Country:US
Practice Address - Phone:512-259-3467
Practice Address - Fax:512-406-7303
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6249208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103451405Medicaid
TX103451402Medicaid
TX103451404Medicaid
TX103451403Medicaid
TX370012083Medicare PIN
TX103451402Medicaid
TX103451404Medicaid
TX87J467Medicare PIN
TX8J0436Medicare PIN