Provider Demographics
NPI:1033134929
Name:DONALD G SPRADLIN DO PLLC
Entity Type:Organization
Organization Name:DONALD G SPRADLIN DO PLLC
Other - Org Name:DONALD G SPRADLIN DO LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRADLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-481-2825
Mailing Address - Street 1:PO BOX 60545
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80960-0545
Mailing Address - Country:US
Mailing Address - Phone:719-481-2825
Mailing Address - Fax:719-481-2825
Practice Address - Street 1:1415 W CHEYENNE MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-6211
Practice Address - Country:US
Practice Address - Phone:719-481-2825
Practice Address - Fax:719-481-2825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04020293Medicaid
COCM3708Medicare PIN