Provider Demographics
NPI:1467743179
Name:SPRADLING, EDD
Entity Type:Individual
Prefix:
First Name:EDD
Middle Name:
Last Name:SPRADLING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 E RANDOL MILL RD
Mailing Address - Street 2:STE 503
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-8292
Mailing Address - Country:US
Mailing Address - Phone:817-299-8012
Mailing Address - Fax:817-299-8095
Practice Address - Street 1:2004 E RANDOL MILL RD
Practice Address - Street 2:STE 503
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-8292
Practice Address - Country:US
Practice Address - Phone:817-299-8012
Practice Address - Fax:817-299-8095
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4465247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX208761101Medicaid
TX208761102Medicaid
TX208761103Medicaid
TX208761103Medicaid