Healthcare Provider Details

I. General information

NPI: 1235367574
Provider Name (Legal Business Name): RYAN DORSEY-SPITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO DR SE BLDG 47
ALBUQUERQUE NM
87108-5153
US

IV. Provider business mailing address

2050A 2ND ST SE
KIRTLAND AFB NM
87117-5522
US

V. Phone/Fax

Practice location:
  • Phone: 505-846-3714
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25879
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: