Provider Demographics
NPI:1669908711
Name:RUBEN, SPENCER (DO)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:RUBEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7236 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-5448
Mailing Address - Country:US
Mailing Address - Phone:602-276-5565
Mailing Address - Fax:602-232-9665
Practice Address - Street 1:7236 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-5448
Practice Address - Country:US
Practice Address - Phone:602-276-5565
Practice Address - Fax:602-232-9665
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ008512207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program