Provider Demographics
NPI:1508849506
Name:SPREI, STANLEY H (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:H
Last Name:SPREI
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 1:100 FOUNTAIN AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-2771
Mailing Address - Country:US
Mailing Address - Phone:270-442-9519
Mailing Address - Fax:270-442-9506
Practice Address - Street 1:1530 LONE OAK RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7901
Practice Address - Country:US
Practice Address - Phone:270-244-2449
Practice Address - Fax:270-244-2462
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI100832207ZP0102X
KY38381207ZP0102X
AZ36385208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYDC1348OtherMEDICARE RAILROAD
KY64075583Medicaid
KYDC1348OtherMEDICARE RAILROAD
KY64075583Medicaid