Provider Demographics
NPI:1366963381
Name:AUGUSTIN, SPENCER RICHARD (DO, FAACAP)
Entity type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:RICHARD
Last Name:AUGUSTIN
Suffix:
Gender:M
Credentials:DO, FAACAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 241889
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99524-1889
Mailing Address - Country:US
Mailing Address - Phone:907-563-1777
Mailing Address - Fax:907-561-7464
Practice Address - Street 1:3201 C ST STE 606
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3971
Practice Address - Country:US
Practice Address - Phone:907-258-7575
Practice Address - Fax:907-561-7464
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1854782084P0804X, 2084P0800X
UT11709387-12042084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1730692Medicaid