Individual
DR. STEPHEN CHARLES SPICER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1103 E GRACE ST, RENSSELAER, IN 47978-3210
(219) 866-4135
(219) 866-0803
Mailing address
PO BOX 4699, LAFAYETTE, IN 47903-4699
(765) 449-2732
(765) 449-1196
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A01021575
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100219620A
—
IN
05
—
1002919620
—
IN
01
—
791083372
PALMETTO GBA
IN
Enumeration date
09/20/2005
Last updated
01/20/2017
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