MEDICARE: DR. ROBERTO R SPENCER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	38428	CO
2	2085R0202X	Diagnostic Radiology Physician	82-314	NM

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	300112303	OTHER	CO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225007446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERTO R SPENCER M.D.

Provider Business Mailing Address
First Line	:	1052 SLEEPY HOLLOW RD
Second Line	:
City	:	GOLDEN
State	:	CO
Zip	:	80401-8037
Country	:	US
Telephone Number	:	303-468-1395
Fax Number	:	303-468-1394

Provider Business Practice Location Address
First Line	:	12687 W CEDAR DR
Second Line	:	200
City	:	LAKEWOOD
State	:	CO
Zip	:	80228-2010
Country	:	US
Telephone Number	:	303-468-1395
Fax Number	:	303-468-1394

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	07/31/2012

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Directions to “ DR. ROBERTO R SPENCER M.D.” Practice Location

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