Provider Demographics
NPI:1023082435
Name:SPINNER, RICHARD LEE (DPM)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEE
Last Name:SPINNER
Suffix:
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 1:1101 N. 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360
Mailing Address - Country:US
Mailing Address - Phone:570-424-6928
Mailing Address - Fax:570-421-5472
Practice Address - Street 1:1101 N. 5TH STREET
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360
Practice Address - Country:US
Practice Address - Phone:570-424-6928
Practice Address - Fax:570-421-5472
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002046L213ES0131X
PASC-002046L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA07632072Medicaid
PA07632072Medicaid
1016480001Medicare NSC