Individual
DR. CHARLA C SPENCER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1720 S BECKHAM AVE STE 104, TYLER, TX 75701-4464
(903) 597-2002
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
L0615
TX
207VG0400X
Gynecology Physician
L0615
TX
207VX0000X
Obstetrics Physician
L0615
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
039151801
—
TX
05
—
039151802
—
TX
05
—
039151804
—
TX
05
—
039151805
—
TX
01
—
123894
SUPERIOR CHIPS
TX
01
—
45-2578435-002
TRICARE
TX
01
—
75-2616977-136
TRICARE
TX
01
—
752616977026
TRICARE
TX
01
—
7600108
AETNA
TX
01
—
8A0740
BCBS OF TEXAS
TX
01
—
8FL328
BCBS
TX
01
—
P01572867
RAIL ROAD MEDICARE
TX
Enumeration date
02/21/2006
Last updated
07/21/2022
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