Healthcare Provider Details

I. General information

NPI: 1861436057
Provider Name (Legal Business Name): EDWARD JOSEPH SPITZ M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10501 GOLF COURSE ROAD
ALBUQUERQUE NM
87114
US

IV. Provider business mailing address

10401 BORREGO CREEK NW
ALBUQUERQUE NM
87114
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-2000
  • Fax:
Mailing address:
  • Phone: 505-899-2186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.012608
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD2006-0648
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: