Provider Demographics
NPI:1174580930
Name:SPENCE, ALLAN BARWISE (MD)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:BARWISE
Last Name:SPENCE
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 1:336 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:RAYMONDVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78580-2526
Mailing Address - Country:US
Mailing Address - Phone:956-689-2456
Mailing Address - Fax:956-689-5157
Practice Address - Street 1:336 S 8TH ST
Practice Address - Street 2:
Practice Address - City:RAYMONDVILLE
Practice Address - State:TX
Practice Address - Zip Code:78580-2526
Practice Address - Country:US
Practice Address - Phone:956-689-2456
Practice Address - Fax:956-689-5157
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5757208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092568701Medicaid
TX092568701Medicaid