Provider Demographics
NPI:1538319355
Name:SPITAEL, BRAM (PA-C)
Entity Type:Individual
Prefix:
First Name:BRAM
Middle Name:
Last Name:SPITAEL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-9702
Mailing Address - Country:US
Mailing Address - Phone:541-412-2000
Mailing Address - Fax:541-412-2081
Practice Address - Street 1:500 5TH STREET
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415
Practice Address - Country:US
Practice Address - Phone:541-412-2000
Practice Address - Fax:541-412-2081
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA153064363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1487696985OtherCURRY GENERAL HOSPITAL NPI
OR500629286Medicaid
1083656367OtherCURRY MEDICAL CENTER NPI
R156445OtherMEDICARE
381322OtherCURRY GENERAL HOSPITAL'S MEDICARE PART A
1083656367OtherCURRY MEDICAL CENTER NPI
R0000ZGBDGOtherCURRY GENERAL HOSPITAL'S MEDICARE PART B