Provider Demographics
NPI:1649398595
Name:SPINAK, RICHARD BARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BARRY
Last Name:SPINAK
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 1:10278 RUDDY DUCK LN
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2971
Mailing Address - Country:US
Mailing Address - Phone:443-614-3161
Mailing Address - Fax:206-350-7604
Practice Address - Street 1:10278 RUDDY DUCK LN
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110
Practice Address - Country:US
Practice Address - Phone:443-614-3161
Practice Address - Fax:206-350-7604
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010566042083X0100X
WAMD 600695852083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B82084Medicare UPIN
GC01552SMedicare ID - Type Unspecified