Provider Demographics
NPI:1326096173
Name:SPAFFORD, GORDON (MD)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:
Last Name:SPAFFORD
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 1:27961 US HIGHWAY 98
Mailing Address - Street 2:SUITE 20
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526
Mailing Address - Country:US
Mailing Address - Phone:251-621-6520
Mailing Address - Fax:251-621-6521
Practice Address - Street 1:27961 US HIGHWAY 98
Practice Address - Street 2:SUITE 20
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526
Practice Address - Country:US
Practice Address - Phone:251-621-6520
Practice Address - Fax:251-621-6521
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00003278207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051513273Medicaid
AL000013273Medicare ID - Type Unspecified
AL051513273Medicaid