MEDICARE: BYRON R SPENCER JR.

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	2084N0400X	Neurology Physician	26743	NE
2	2084N0400X	Neurology Physician	34604	AZ
3	2084N0400X	Neurology Physician	DR.0049146	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	COA105232	OTHER	CO	MEMORIAL HOSPITAL UPIN

General Provider Information

NPI Number	:	1518941343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BYRON R SPENCER JR.

Provider Business Mailing Address
First Line	:	P.O. BOX 17326
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80217-7326
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	499 E HAMPDEN AVE
Second Line	:	STE 360
City	:	ENGLEWOOD
State	:	CO
Zip	:	80113-2780
Country	:	US
Telephone Number	:	303-781-4485
Fax Number	:

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

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	10/04/2017

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