Healthcare Provider Details

I. General information

NPI: 1003980459
Provider Name (Legal Business Name): MARGARET PEGGY SPENCER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARGARET R SPENCER MD

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO DR SE
ALBUQUERQUE NM
87108-5153
US

IV. Provider business mailing address

1501 SAN PEDRO DR SE
ALBUQUERQUE NM
87108-5153
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-1711
  • Fax: 505-256-6414
Mailing address:
  • Phone: 505-265-1711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number89100
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: