Provider Demographics
NPI:1093039521
Name:SPAIN, CHAD ALAN (MD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:ALAN
Last Name:SPAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3745 WEST 4700 SOUTH
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84129
Mailing Address - Country:US
Mailing Address - Phone:801-840-2100
Mailing Address - Fax:801-840-2139
Practice Address - Street 1:3745 WEST 4700 SOUTH
Practice Address - Street 2:FAMILY PRACTICE
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129
Practice Address - Country:US
Practice Address - Phone:801-840-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT81373561205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine