Basic Information
| Provider Information | |||||||||
| NPI: | 1225007446 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPENCER | ||||||||
| FirstName: | ROBERTO | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1052 SLEEPY HOLLOW RD | ||||||||
| Address2: | |||||||||
| City: | GOLDEN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804018037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034681395 | ||||||||
| FaxNumber: | 3034681394 | ||||||||
| Practice Location | |||||||||
| Address1: | 12687 W CEDAR DR | ||||||||
| Address2: | 200 | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802282010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034681395 | ||||||||
| FaxNumber: | 3034681394 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 07/31/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 38428 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 82-314 | NM | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 300112303 | 01 | CO | RAILROAD MEDICARE | OTHER | 58925767 | 05 | CO | MEDICAID |