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SPENCER COREY SOUTHERLAND IDC
NPI 1922359702
Military Health Care Provider in Jbphh, HI

Active since September 20, 2012
480 CENTRAL AVE, JBPHH, HI 96860(808) 869-2600 Get Directions Write a Review

NPPES record last updated: April 3, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Spencer Corey Southerland Idc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SPENCER COREY SOUTHERLAND IDC (NPI 1922359702) is an individual military health care provider provider in Jbphh, Hawaii and active in the NPI registry since September 2012.

NPPES Registry Identity

NPI1922359702
Entity TypeIndividualMale
Primary Taxonomy171000000X
Provider Legal NameSPENCER COREY SOUTHERLANDCredential: IDC
Location Address480 CENTRAL AVEJbphh, HI 96860-4908
Mailing AddressSeal Team 2, Unit 60003Fpo, AE 09501-4633
Phone(808) 869-2600
Sole ProprietorNo
Enumeration DateSeptember 20, 2012
Last NPPES UpdateApril 3, 2025
NPPES CertifiedApril 3, 2025
✔ NPI 1922359702 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMilitary Health Care ProviderOther Service Providers
Taxonomy Code171000000X
Definition
Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes.
480 CENTRAL AVE, Jbphh, HI 96860
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JOHN KNOREK PH.D.
Psychologist
480 CENTRAL AVE
PEARL HARBOR, HI 96860
Honolulu County (808) 474-4242
MR. DENNIS T SEKINE MS, MPH, CCC-A
Audiologist
480 CENTRAL AVE
PEARL HARBOR, HI 96860
Honolulu County (808) 474-0628
MR. KEVIN THOMAS COHN HM2/P.T. TEHCNICIAN
Technician
480 CENTRAL AVE
PEARL HARBOR, HI 96860
Honolulu County (808) 257-8708
CHRISTOPHER G PELLEJERA O.D.
Optometrist
480 CENTRAL AVE
PEARL HARBOR, HI 96860
Honolulu County (808) 474-4248
MR. DEMETRIUS PRUITT APRN
Nurse Practitioner (Family)
480 CENTRAL AVE
PEARL HARBOR, HI 96860
Honolulu County (808) 477-2600
TAYLOR ANNE STUBBLEFIELD IDC
Military Health Care Provider (Independent Duty Corpsman)
480 CENTRAL AVE
PEARL HARBOR, HI 96860
Honolulu County (951) 442-2444
BENJAMIN CLARKSON JAMES DPT
Physical Therapist
480 CENTRAL AVE
PEARL HARBOR, HI 96860
Honolulu County (808) 474-4242
MR. JUDE COLEMAN PHARMACIST
Pharmacist
480 CENTRAL AVE
PEARL HARBOR, HI 96860
Honolulu County (808) 473-1880

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Spencer Southerland's NPI number?

The NPI number for Spencer Southerland is 1922359702. It was assigned to this individual provider in the NPPES registry on September 20, 2012.

Where is Spencer Southerland located?

Spencer Southerland practices at 480 Central Ave, Jbphh, HI 96860. The listed phone number is (808) 869-2600.

What is Spencer Southerland's specialty?

The primary specialty registered for this NPI is Military Health Care Provider with taxonomy code 171000000X.

When was this NPI record last updated?

The NPPES record for Spencer Southerland was last updated on April 3, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.