Provider Demographics
NPI:1922189000
Name:SPAK, WILLIAM J (DPM)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:SPAK
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:1011 W LA PALMA AVE
Mailing Address - Street 2:#100
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801
Mailing Address - Country:US
Mailing Address - Phone:714-774-1550
Mailing Address - Fax:714-774-0616
Practice Address - Street 1:1011 W LA PALMA AVE
Practice Address - Street 2:#100
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-3661
Practice Address - Country:US
Practice Address - Phone:714-774-1550
Practice Address - Fax:714-774-0616
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE3517213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E35170Medicaid
CAU17334Medicare UPIN