Provider Demographics
NPI:1689690802
Name:SPIVEY, MARIA I (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:I
Last Name:SPIVEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 CHILDRENS PL
Mailing Address - Street 2:C B 8116
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1002
Mailing Address - Country:US
Mailing Address - Phone:314-454-2341
Mailing Address - Fax:314-454-4345
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-2341
Practice Address - Fax:314-454-4345
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2002010255208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209137108Medicaid
MO209137108Medicaid
923780381Medicare PIN
I21582Medicare UPIN