Healthcare Provider Details

I. General information

NPI: 1780095141
Provider Name (Legal Business Name): BRYCE C SPITZE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 A ST
GREELEY CO
80631
US

IV. Provider business mailing address

1600 23RD AVE
GREELEY CO
80634-6070
US

V. Phone/Fax

Practice location:
  • Phone: 970-313-0400
  • Fax: 970-313-0404
Mailing address:
  • Phone: 970-346-2800
  • Fax: 970-346-2774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number56191
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: