Individual
DR. SPENCER STEPHEN SEBALLOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
777 BANNOCK ST # MC0108, DENVER, CO 80204-4507
(303) 602-5193
Mailing address
777 BANNOCK ST # MC0108, DENVER, CO 80204-4507
(303) 602-5193
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
DR.0074817
CO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
029733
KAISER COMMERCIAL NUMBER
CO
05
—
9000220106
—
CO
Enumeration date
03/21/2022
Last updated
07/08/2025
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