Provider Demographics
NPI:1922059302
Name:SPAINHOUR, JACK B JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:B
Last Name:SPAINHOUR
Suffix:JR
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 1:101 HOLBROOK ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-1732
Mailing Address - Country:US
Mailing Address - Phone:434-792-4041
Mailing Address - Fax:
Practice Address - Street 1:101 HOLBROOK ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1732
Practice Address - Country:US
Practice Address - Phone:434-792-4041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101023423207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101023423OtherMEDICAL LICENSE NUMBER
VA0101023423OtherMEDICAL LICENSE NUMBER
VA0101023423OtherMEDICAL LICENSE NUMBER