Provider Demographics
NPI:1225007446
Name:SPENCER, ROBERTO R (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:R
Last Name:SPENCER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1052 SLEEPY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-8037
Mailing Address - Country:US
Mailing Address - Phone:303-468-1395
Mailing Address - Fax:303-468-1394
Practice Address - Street 1:12687 W CEDAR DR
Practice Address - Street 2:200
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-2010
Practice Address - Country:US
Practice Address - Phone:303-468-1395
Practice Address - Fax:303-468-1394
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO384282085R0202X
NM82-3142085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO300112303OtherRAILROAD MEDICARE
CO58925767Medicaid
COE11124Medicare UPIN
COC213668Medicare PIN
COC230048Medicare PIN
CO58925767Medicaid