Provider Demographics
NPI:1073554085
Name:SPALDING, JOSEPH L (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:SPALDING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 HOSPITAL DR
Mailing Address - Street 2:P O BOX 1239
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-6890
Mailing Address - Country:US
Mailing Address - Phone:573-629-3370
Mailing Address - Fax:573-406-5750
Practice Address - Street 1:3145 HIGHWAY 61 STE A
Practice Address - Street 2:MENTAL HEALTH
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-6588
Practice Address - Country:US
Practice Address - Phone:573-629-3370
Practice Address - Fax:573-406-5750
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001461522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CU0751OtherRR MEDICARE
H62325OtherMERCY
2114411OtherHEALTHLINK
MO245852702Medicaid
166315OtherBLUE CROSS BLUE SHIELD
MO505995001Medicaid
260051270OtherRR MEDICARE
000013680Medicare ID - Type Unspecified
MO505995001Medicaid
MO245852702Medicaid