Healthcare Provider Details

I. General information

NPI: 1225007446
Provider Name (Legal Business Name): ROBERTO R SPENCER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12687 W CEDAR DR 200
LAKEWOOD CO
80228-2010
US

IV. Provider business mailing address

1052 SLEEPY HOLLOW RD
GOLDEN CO
80401-8037
US

V. Phone/Fax

Practice location:
  • Phone: 303-468-1395
  • Fax: 303-468-1394
Mailing address:
  • Phone: 303-468-1395
  • Fax: 303-468-1394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number38428
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number82-314
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: