Provider Demographics
NPI:1255361473
Name:SPAETH, STEFANIE D (MD)
Entity type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:D
Last Name:SPAETH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9101 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 420
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-5927
Mailing Address - Country:US
Mailing Address - Phone:214-823-2525
Mailing Address - Fax:214-826-0466
Practice Address - Street 1:9101 N CENTRAL EXPY
Practice Address - Street 2:SUITE 420
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5927
Practice Address - Country:US
Practice Address - Phone:214-823-2525
Practice Address - Fax:214-826-0466
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK7217208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0428187-02Medicaid
TX8C1707Medicare PIN
TX0428187-02Medicaid