Provider Demographics
NPI:1871698852
Name:SPENCER, SARAH C (DO)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:C
Last Name:SPENCER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 39386
Mailing Address - Street 2:
Mailing Address - City:NINILCHIK
Mailing Address - State:AK
Mailing Address - Zip Code:99639-0386
Mailing Address - Country:US
Mailing Address - Phone:907-567-3970
Mailing Address - Fax:907-567-3902
Practice Address - Street 1:15765 KINSLEY RD
Practice Address - Street 2:
Practice Address - City:NINILCHIK
Practice Address - State:AK
Practice Address - Zip Code:99639
Practice Address - Country:US
Practice Address - Phone:907-567-3970
Practice Address - Fax:907-567-3902
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MET0864207Q00000X
AK6673207Q00000X
AKMEDO6673207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432681299Medicaid