Spedale Md Pc | |
3113 Wesley Way Ste 1 Dothan AL 36305-2004 | |
(334) 699-5123 | |
(334) 699-5125 |
Full Name | Spedale Md Pc |
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Speciality | Clinic/Center |
Location | 3113 Wesley Way Ste 1, Dothan, Alabama |
Authorized Official Name and Position | Anthony Roland Spedale (PHYSICIAN) |
Authorized Official Contact | 3346995123 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Spedale Md Pc 3113 Wesley Way Ste 1 Dothan AL 36305-2004 Ph: (334) 699-5123 | Spedale Md Pc 3113 Wesley Way Ste 1 Dothan AL 36305-2004 Ph: (334) 699-5123 |
NPI Number | 1184273096 |
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Provider Enumeration Date | 09/04/2019 |
Last Update Date | 11/06/2020 |
Medicare PECOS PAC ID | 3779815477 |
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Medicare Enrollment ID | O20191030000905 |
Identifier | Type | State | Issuer |
---|---|---|---|
1184273096 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Anthony Spedale |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1699778662 PECOS PAC ID: 1052491594 Enrollment ID: I20100517000099 |
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