Healthcare Provider Details

I. General information

NPI: 1811980733
Provider Name (Legal Business Name): MARC SPENCER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E HAMPDEN AVE
ENGLEWOOD CO
80113-3879
US

IV. Provider business mailing address

2520 FAIRFAX ST
DENVER CO
80207-3221
US

V. Phone/Fax

Practice location:
  • Phone: 303-788-6490
  • Fax: 303-788-5451
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37390
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: