Provider Demographics
NPI:1699119487
Name:PIERSON, SPENCER EDMOND (MD)
Entity type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:EDMOND
Last Name:PIERSON
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 1:5063 S COTTONWOOD ST STE 400
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6773
Mailing Address - Country:US
Mailing Address - Phone:801-507-1950
Mailing Address - Fax:801-507-1951
Practice Address - Street 1:5063 S COTTONWOOD ST STE 400
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6773
Practice Address - Country:US
Practice Address - Phone:801-507-1950
Practice Address - Fax:801-507-1951
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9148242-1205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty