Provider Demographics
NPI:1326146911
Name:SPIVEY, OSCAR SMITH JR (MD)
Entity Type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:SMITH
Last Name:SPIVEY
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1550 SPARTA ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MC MINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-1315
Mailing Address - Country:US
Mailing Address - Phone:931-473-1526
Mailing Address - Fax:931-473-1528
Practice Address - Street 1:1550 SPARTA ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MC MINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1315
Practice Address - Country:US
Practice Address - Phone:931-473-1526
Practice Address - Fax:931-473-1528
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
TNMD12960208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3188305Medicaid
TN3188305Medicare ID - Type Unspecified
TN3188305Medicaid