SPENCER, ELIZABETH BROOKE (MD)

Provider Demographics

• NPI: 1740279504
• Name: SPENCER, ELIZABETH BROOKE (MD)
• Entity type: Individual
• First Name: ELIZABETH
• Middle Name: BROOKE
• Last Name: SPENCER
• Gender: F
• Credentials: MD
• Other - First Name: E.
• Other - Middle Name: BROOKE
• Other - Last Name: SPENCER
• Other - Last Name Type: Other Name
• Other - Credentials: MD
• Mailing Address - Street 1: 8671 S QUEBEC ST STE 200
• Mailing Address - City: HIGHLANDS RANCH
• Mailing Address - State: CO
• Mailing Address - Zip Code: 80130-5861
• Mailing Address - Country: US
• Mailing Address - Phone: 303-805-7477
• Mailing Address - Fax: 303-805-7478
• Practice Address - Street 1: 8671 S QUEBEC ST STE 200
• Practice Address - City: HIGHLANDS RANCH
• Practice Address - State: CO
• Practice Address - Zip Code: 80130
• Practice Address - Country: US
• Practice Address - Phone: 303-805-7477
• Practice Address - Fax: 303-805-7478
• Is Sole Proprietor?: No
• Enumeration Date: 2005-10-14
• Last Update Date: 2025-01-30

Provider Licenses

State	License ID	Taxonomies
CO	48034	2085R0202X
CO	CDRH.0048034	2085R0204X
NE	25424	2085R0202X
KS	04-36418	2085R0202X
HI	MD17583	2085R0202X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	2085R0204X	Allopathic & Osteopathic Physicians	Radiology	Vascular & Interventional Radiology
No	2085R0202X	Allopathic & Osteopathic Physicians	Radiology	Diagnostic Radiology

Provider Identifiers

State	Identifier ID	ID Type	Issuer
KS	200631240A	Medicaid
AZ	581662	Medicaid
MT	1740279504	Medicaid
CO	04803736	Medicaid
NE	84059792913	Medicaid
NE	10025709000	Medicaid
NM	84682558	Medicaid
WY	1740279504	Medicaid
NE	P01479814	Other	RAIL ROAD MEDICARE RIN
NE	84059792913	Medicaid
NE	NA1214057	Medicare PIN
CO	04803736	Medicaid
KS	KA3249019	Medicare PIN
NE	NA2517048	Medicare PIN
CO	P00779054	Medicare PIN
KS	111257042	Medicare PIN
CO	CO306297	Medicare PIN
CO	P01540418	Medicare PIN
NM	84682558	Medicaid
CO	CO306296	Medicare PIN
NE	10025709000	Medicaid