Provider Demographics
NPI:1093947434
Name:TODD A SPENCER, MD, PA
Entity type:Organization
Organization Name:TODD A SPENCER, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-806-0777
Mailing Address - Street 1:PO BOX 269092
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-9092
Mailing Address - Country:US
Mailing Address - Phone:469-806-0777
Mailing Address - Fax:469-694-8434
Practice Address - Street 1:11970 N CENTRAL EXPY STE 630
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3793
Practice Address - Country:US
Practice Address - Phone:972-566-7188
Practice Address - Fax:972-566-2312
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TODD A SPENCER,MD, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-19
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL38392086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157541702Medicaid
TX0038TAOtherBCBS
TX157541702Medicaid
TX0A5348Medicare PIN