Provider Demographics
NPI:1316387079
Name:SPANGLER, TAMERA SHEA (DO)
Entity Type:Individual
Prefix:DR
First Name:TAMERA
Middle Name:SHEA
Last Name:SPANGLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 636493
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6493
Mailing Address - Country:US
Mailing Address - Phone:513-981-5130
Mailing Address - Fax:513-981-5015
Practice Address - Street 1:1100 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:KY
Practice Address - Zip Code:40336-7231
Practice Address - Country:US
Practice Address - Phone:606-723-7706
Practice Address - Fax:606-726-9410
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY03707207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100293400Medicaid