Provider Demographics
NPI:1053670810
Name:SPENCER, DORAN BOTT
Entity type:Individual
Prefix:
First Name:DORAN
Middle Name:BOTT
Last Name:SPENCER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 MAIN ST
Mailing Address - Street 2:STE 201
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1640
Mailing Address - Country:US
Mailing Address - Phone:781-891-6377
Mailing Address - Fax:781-647-1430
Practice Address - Street 1:5901 EAST SEVENTH STREET
Practice Address - Street 2:VA LONG BEACH
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90822
Practice Address - Country:US
Practice Address - Phone:562-826-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA266283207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology