Provider Demographics
NPI:1134209273
Name:SPANN, JAMES CREED (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CREED
Last Name:SPANN
Suffix:
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 1:2708 S RIFE MEDICAL LN STE 210
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1456
Mailing Address - Country:US
Mailing Address - Phone:793-383-8888
Mailing Address - Fax:479-338-4453
Practice Address - Street 1:2708 S RIFE MEDICAL LN STE 210
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1456
Practice Address - Country:US
Practice Address - Phone:793-383-8888
Practice Address - Fax:479-338-4453
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20598208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100074920AMedicaid
AR134328001Medicaid
OK1134209273OtherOK STATE EMPLOYEES (HEALTHCHOICE
AR295AOtherMEDICARE
AR5I124OtherBLUE CROSS BLUE SHIELD
P01068164OtherRAILROAD MEDICARE
AR295AOtherMEDICARE