Provider Demographics
NPI:1578534236
Name:SPEWAK, ROBERT D (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:SPEWAK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 505460
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5460
Mailing Address - Country:US
Mailing Address - Phone:314-353-8777
Mailing Address - Fax:314-353-8772
Practice Address - Street 1:6526 LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2654
Practice Address - Country:US
Practice Address - Phone:314-353-8777
Practice Address - Fax:314-353-8772
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2024-05-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR9A17208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203009600Medicaid