Provider Demographics
NPI:1013024678
Name:SPAULDING, DUANE RYAN (MD, FACP)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:RYAN
Last Name:SPAULDING
Suffix:
Gender:M
Credentials:MD, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6722 NORTHFACE LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1509
Mailing Address - Country:US
Mailing Address - Phone:719-590-9338
Mailing Address - Fax:
Practice Address - Street 1:6722 NORTHFACE LN
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1509
Practice Address - Country:US
Practice Address - Phone:719-590-9338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO023347207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01233477Medicaid
COD24264Medicare UPIN
COD24264Medicare UPIN