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Individual

MR. DONAVAN D SPENCER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
205 SOUTH ST, FORT BRAGG, CA 95437-5540
(707) 964-1251
Mailing address
205 SOUTH ST, FORT BRAGG, CA 95437-5540
(707) 964-1251

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
G85455
CA
208000000X
Pediatrics Physician
MD26431
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00G854550
BS OF CA
CA
05
00G854550
CA
Enumeration date
06/27/2006
Last updated
11/11/2022
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