Individual
MR. SPENCER EMERSON DEROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
595 STRAITS TPKE, WATERTOWN, CT 06795-3393
(844) 482-7285
(203) 502-2615
Mailing address
22 LISBON ST, WATERTOWN, CT 06795-2669
(860) 274-6653
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
5918
CT
363A00000X
Physician Assistant
5918
CT
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
10/06/2022
Last updated
06/16/2025
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