Healthcare Provider Details

I. General information

NPI: 1881852978
Provider Name (Legal Business Name): LOREN KEMP SPENCER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 INDIAN WELLS RD SUITE A
ALAMOGORDO NM
88310-4611
US

IV. Provider business mailing address

2301 INDIAN WELLS RD STE A
ALAMOGORDO NM
88310-4611
US

V. Phone/Fax

Practice location:
  • Phone: 575-434-0639
  • Fax: 575-434-4148
Mailing address:
  • Phone: 575-434-0639
  • Fax: 575-434-4148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number335
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number335
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number335
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License Number335
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number335
License Number StateNM
# 6
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number335
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: