Provider Demographics
NPI:1750368247
Name:SPENCER, MARTHA L (MD)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:L
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 PARK NICOLETT BLVD.
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2699
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3800 PARK NICOLETT BLVD.
Practice Address - Street 2:PEDIATRIC ENDOCRINOLOGY
Practice Address - City:ST. LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2699
Practice Address - Country:US
Practice Address - Phone:952-993-3900
Practice Address - Fax:952-993-1761
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN274222080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology