Provider Demographics
NPI:1568405330
Name:SPITALNY, A. DOUGLAS (DPM)
Entity Type:Individual
Prefix:
First Name:A.
Middle Name:DOUGLAS
Last Name:SPITALNY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2546
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-2546
Mailing Address - Country:US
Mailing Address - Phone:620-783-4441
Mailing Address - Fax:620-783-4090
Practice Address - Street 1:MCXP-CCS-CR
Practice Address - Street 2:GENERAL LEONARD WOOD COMMUNITY HOSPITAL
Practice Address - City:FT. LEONARD WOOD
Practice Address - State:MO
Practice Address - Zip Code:65473-1267
Practice Address - Country:US
Practice Address - Phone:573-596-1764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN748213ES0131X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN594197100Medicaid
V04353Medicare UPIN
MN594197100Medicaid