Provider Demographics
NPI:1952051138
Name:MAMER, SPENCER BRUCE (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:BRUCE
Last Name:MAMER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 W MAIN ST STE 115
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-4474
Mailing Address - Country:US
Mailing Address - Phone:500-813-2000
Mailing Address - Fax:
Practice Address - Street 1:720 W MAIN ST STE 115
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-4474
Practice Address - Country:US
Practice Address - Phone:503-813-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0072254207Q00000X
ORMD226746207Q00000X
WAMD.70013272207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000206295Medicaid
CO029600OtherKAISER COMMERCIAL NUMBER