Healthcare Provider Details

I. General information

NPI: 1407353907
Provider Name (Legal Business Name): SPENCER HARDY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6104 E BROWN RD STE 101
MESA AZ
85205-4953
US

IV. Provider business mailing address

1119 S RICO
MESA AZ
85204-5526
US

V. Phone/Fax

Practice location:
  • Phone: 480-219-4100
  • Fax: 877-258-1138
Mailing address:
  • Phone: 480-204-7118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD-000998
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberPOD-000998
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD-000998
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: