Provider Demographics
NPI:1821357179
Name:ANDERSON, MARK SPENCER (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:SPENCER
Last Name:ANDERSON
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 1:101 HOSPITAL LOOP NE STE 201
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2128
Mailing Address - Country:US
Mailing Address - Phone:505-727-5443
Mailing Address - Fax:505-727-9401
Practice Address - Street 1:101 HOSPITAL LOOP NE STE 201
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2128
Practice Address - Country:US
Practice Address - Phone:505-727-4430
Practice Address - Fax:505-727-9401
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2019-0224207X00000X, 207XS0106X
NMRS2018-0355390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM48476854Medicaid