Healthcare Provider Details

I. General information

NPI: 1114078797
Provider Name (Legal Business Name): SPENCER EMIL LUDLOW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2119 PACIFIC BLVD SW STE 101
ALBANY OR
97321-1414
US

IV. Provider business mailing address

2119 PACIFIC BLVD SW STE 101
ALBANY OR
97321-1414
US

V. Phone/Fax

Practice location:
  • Phone: 541-926-5848
  • Fax:
Mailing address:
  • Phone: 541-926-5848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD167130
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: