Basic Information
| Provider Information | |||||||||
| NPI: | 1104970623 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPENCER | ||||||||
| FirstName: | EMERALD | ||||||||
| MiddleName: | MARTIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 505 ORTEGA ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941224623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156610347 | ||||||||
| FaxNumber: | 4157532367 | ||||||||
| Practice Location | |||||||||
| Address1: | 3801 SACRAMENTO ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941181625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156002402 | ||||||||
| FaxNumber: | 4153799870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | G007238 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.