Provider Demographics
NPI:1205053758
Name:MCSPADDEN, FARRAH TRAQUEL (MD)
Entity type:Individual
Prefix:DR
First Name:FARRAH
Middle Name:TRAQUEL
Last Name:MCSPADDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3098 OAK GROVE RD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-8938
Mailing Address - Country:US
Mailing Address - Phone:573-776-9484
Mailing Address - Fax:573-776-9486
Practice Address - Street 1:3098 OAK GROVE RD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-8938
Practice Address - Country:US
Practice Address - Phone:573-776-9484
Practice Address - Fax:573-776-9486
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301086477207VH0002X
MO2009023901207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative Medicine