Basic Information
| Provider Information | |||||||||
| NPI: | 1386887917 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPENCER | ||||||||
| FirstName: | LEE | ||||||||
| MiddleName: | SAMUEL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8226 DOUGLAS AVE STE 805 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752255930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143457355 | ||||||||
| FaxNumber: | 2143458753 | ||||||||
| Practice Location | |||||||||
| Address1: | 8226 DOUGLAS AVE STE 805 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2149375884 | ||||||||
| FaxNumber: | 2143733404 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2009 | ||||||||
| LastUpdateDate: | 02/02/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0802X | P7038 | TX | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2084P0800X | P7038 | TX | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.