Provider Demographics
NPI:1558334011
Name:SPENCER, DALE A (DO)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:A
Last Name:SPENCER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-2420
Mailing Address - Fax:303-765-6640
Practice Address - Street 1:9480 BRIAR VILLAGE PT STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7923
Practice Address - Country:US
Practice Address - Phone:719-278-3627
Practice Address - Fax:719-623-2101
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0043582207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000170910Medicaid
CO14457318Medicaid
COI42352Medicare UPIN