Provider Demographics
NPI:1346252855
Name:SPENCER, ROBERT (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:SPENCER
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47871 SENECA LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SARAHSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43779-9794
Mailing Address - Country:US
Mailing Address - Phone:740-525-0422
Mailing Address - Fax:
Practice Address - Street 1:304 MAIN STREET
Practice Address - Street 2:CALDWELL CLINIC
Practice Address - City:CALDWELL
Practice Address - State:OH
Practice Address - Zip Code:43724-1396
Practice Address - Country:US
Practice Address - Phone:740-732-2339
Practice Address - Fax:740-732-2350
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-4380207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0668282Medicaid
OH7127002Medicare PIN
OHA17005Medicare UPIN
0601357Medicare PIN