Provider Demographics
NPI:1417240961
Name:SPENDLOVE, SCOTT P (DO)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:P
Last Name:SPENDLOVE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8524 W GAGE BLVD
Mailing Address - Street 2:BLDG A1 BOX 319
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-8241
Mailing Address - Country:US
Mailing Address - Phone:509-591-0070
Mailing Address - Fax:509-396-9661
Practice Address - Street 1:1414 N VERCLER RD STE 5
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1092
Practice Address - Country:US
Practice Address - Phone:206-538-6300
Practice Address - Fax:206-538-6301
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP9464207L00000X
WAOP60640664207LP2900X, 208VP0014X
IDO-1293208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2064650Medicaid
TX349814901Medicaid
TX349814902OtherCSHCN
WA2064650Medicaid
TX349814901Medicaid