Provider Demographics
NPI:1003301979
Name:PANKRATZ, SPENCER (CNIM, REEGT)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:PANKRATZ
Suffix:
Gender:M
Credentials:CNIM, REEGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 S 1200 E APT 1
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1652
Mailing Address - Country:US
Mailing Address - Phone:435-241-8505
Mailing Address - Fax:
Practice Address - Street 1:4600 S ULSTER ST STE 125
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-2848
Practice Address - Country:US
Practice Address - Phone:720-287-3093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-24
Last Update Date:2018-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3187246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic