Provider Demographics
NPI:1366203440
Name:SPENCER, ROBERT GILES
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:GILES
Last Name:SPENCER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10895 NE SPENCER RD
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:OK
Mailing Address - Zip Code:73538-3746
Mailing Address - Country:US
Mailing Address - Phone:580-591-2604
Mailing Address - Fax:
Practice Address - Street 1:10895 NE SPENCER RD
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:OK
Practice Address - Zip Code:73538-3746
Practice Address - Country:US
Practice Address - Phone:580-591-2604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist