Provider Demographics
NPI:1386887917
Name:SPENCER, LEE SAMUEL (MD)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:SAMUEL
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 1:8226 DOUGLAS AVE STE 805
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-5930
Mailing Address - Country:US
Mailing Address - Phone:214-345-7355
Mailing Address - Fax:214-345-8753
Practice Address - Street 1:8226 DOUGLAS AVE STE 805
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225
Practice Address - Country:US
Practice Address - Phone:214-937-5884
Practice Address - Fax:214-373-3404
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2019-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP70382084P0802X, 2084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX376239YKQLMedicare PIN