Provider Demographics
NPI:1760410260
Name:SPALDING, ROBERT TUCKER JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:TUCKER
Last Name:SPALDING
Suffix:JR
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 1:1225 TAFT HWY
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-3251
Mailing Address - Country:US
Mailing Address - Phone:423-756-3668
Mailing Address - Fax:423-886-1142
Practice Address - Street 1:1225 TAFT HWY
Practice Address - Street 2:
Practice Address - City:SIGNAL MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37377-3251
Practice Address - Country:US
Practice Address - Phone:423-756-3668
Practice Address - Fax:423-886-1142
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN528213EP1101X, 213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU73531Medicare UPIN
TN3352920Medicare ID - Type Unspecified