Basic Information
| Provider Information | |||||||||
| NPI: | 1316110927 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPENCER | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | BRADLEY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1677 AMBER GROVE LN | ||||||||
| Address2: | |||||||||
| City: | COLLIERVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380172152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014132133 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6019 WALNUT GROVE RD | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381202113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012263610 | ||||||||
| FaxNumber: | 9012263612 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2008 | ||||||||
| LastUpdateDate: | 01/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 47081 | TN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 208M00000X | 47081 | TN | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 47081 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.