1417155391 NPI number — DR. SCOTT SIMNER SPENCER M.D, MPH

Table of content: DR. SCOTT SIMNER SPENCER M.D, MPH (NPI 1417155391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417155391 NPI number — DR. SCOTT SIMNER SPENCER M.D, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPENCER
Provider First Name:
SCOTT
Provider Middle Name:
SIMNER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D, MPH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417155391
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1510 DIVISION ST., STE. 280
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OREGON CITY
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-905-3400
Provider Business Mailing Address Fax Number:
503-905-3399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2701 NW VAUGHN ST.
Provider Second Line Business Practice Location Address:
SUITE 360
Provider Business Practice Location Address City Name:
PORTLAN
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-227-0671
Provider Business Practice Location Address Fax Number:
503-227-0676
Provider Enumeration Date:
07/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  4811 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: MD158012 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 500647916 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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