Healthcare Provider Details

I. General information

NPI: 1063948396
Provider Name (Legal Business Name): SPENCER J MENAPACE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2017
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N ALVERNON WAY STE 101
TUCSON AZ
85711-1830
US

IV. Provider business mailing address

707 N ALVERNON WAY STE 101
TUCSON AZ
85711-1830
US

V. Phone/Fax

Practice location:
  • Phone: 520-694-8888
  • Fax: 520-694-1640
Mailing address:
  • Phone: 520-694-8888
  • Fax: 520-694-1640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberAZ010254
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAZ010254
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: