Individual
MARK SPENCER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1608 ROAD 44, PASCO, WA 99301-2667
(509) 543-9820
(509) 545-6275
Mailing address
1608 ROAD 44, PASCO, WA 99301-2667
(509) 543-9820
(509) 545-6275
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00022856
WA
207Q00000X
Family Medicine Physician
MD164782
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366407181
—
WA
01
—
263783
LABOR & INDUSTRIES
WA
01
—
R07056
REGENCE BLUE SHIELD
—
Enumeration date
04/18/2006
Last updated
03/24/2021
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