Provider Demographics
NPI:1629037585
Name:SPANOS, WENDY LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:LEIGH
Last Name:SPANOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1107 E MATTHEWS AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4315
Mailing Address - Country:US
Mailing Address - Phone:870-935-0700
Mailing Address - Fax:870-935-0706
Practice Address - Street 1:1107 E MATTHEWS AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4315
Practice Address - Country:US
Practice Address - Phone:870-935-0700
Practice Address - Fax:870-935-0706
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARC7731207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR124127001Medicaid
AR53915Medicare ID - Type Unspecified
ARE45523Medicare UPIN