| Spedale MD PC | |
|
3113 Wesley Way Ste 1 Dothan AL 36305-2004 | |
| (334) 699-5123 | |
| (334) 699-5125 |
| Full Name | Spedale MD PC |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 09/04/2019 |
| Last Update Date | 11/06/2020 |
| Certification Date | 11/06/2020 |
| Medicare PECOS PAC ID | 3779815477 |
|---|---|
| Medicare Enrollment ID | O20191030000905 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184273096 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Primary |
| Provider Name | Anthony Spedale |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699778662 PECOS PAC ID: 1052491594 Enrollment ID: I20100517000099 |
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