Provider Demographics
NPI:1447284583
Name:SPENCER, GENE DAVID JR (MD)
Entity type:Individual
Prefix:
First Name:GENE
Middle Name:DAVID
Last Name:SPENCER
Suffix:JR
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 1:7550 WOLF RIVER BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1745
Mailing Address - Country:US
Mailing Address - Phone:901-542-6801
Mailing Address - Fax:901-542-6871
Practice Address - Street 1:7550 WOLF RIVER BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1745
Practice Address - Country:US
Practice Address - Phone:901-542-6801
Practice Address - Fax:901-542-6871
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000023472207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3031202Medicaid
TN3069960Medicaid
AR96815OtherBLUE CROSS
AR122674001Medicaid
TN3031202OtherBLUE CROSS BLUE SHIELD
MO203599402Medicaid
MS0112994Medicaid
TN3069960Medicaid
MO203599402Medicaid
TN000000004712Medicare ID - Type UnspecifiedMEMPHIS MANAGED CARE
TN3031202Medicaid