Provider Demographics
NPI:1902801020
Name:SPENCER, JEAN B (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:B
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JEAN
Other - Middle Name:F
Other - Last Name:BEATTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:309 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-2946
Mailing Address - Country:US
Mailing Address - Phone:641-754-6200
Mailing Address - Fax:641-754-6245
Practice Address - Street 1:6000 UNIVERSITY AVE
Practice Address - Street 2:STE 210
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8203
Practice Address - Country:US
Practice Address - Phone:515-222-1180
Practice Address - Fax:515-222-9635
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23328207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0066860Medicaid
IA0066860Medicaid
IAA25043Medicare UPIN