Healthcare Provider Details

I. General information

NPI: 1861832255
Provider Name (Legal Business Name): SPENCER K HANSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ROCKY MOUNTAIN AVE STE 100
LOVELAND CO
80538-9004
US

IV. Provider business mailing address

2500 ROCKY MOUNTAIN AVE STE 100
LOVELAND CO
80538-9004
US

V. Phone/Fax

Practice location:
  • Phone: 970-624-1800
  • Fax: 970-624-1891
Mailing address:
  • Phone: 970-624-1800
  • Fax: 970-624-1891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTL.0004939
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA167495
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberDR.0058411
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA167495
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number15432A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: