Provider Demographics
NPI:1245213289
Name:SPALDING, THERESA ROSE (MD)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:ROSE
Last Name:SPALDING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100F W DEAN KEETON ST
Mailing Address - Street 2:#2.212
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78712-1006
Mailing Address - Country:US
Mailing Address - Phone:512-475-8371
Mailing Address - Fax:512-471-0898
Practice Address - Street 1:100 W DEAN KEETON ST
Practice Address - Street 2:#2.212
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-1006
Practice Address - Country:US
Practice Address - Phone:512-475-8371
Practice Address - Fax:512-471-0898
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG8431207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine