Provider Demographics
NPI:1356398739
Name:SPADY, STEVEN D (DO)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:D
Last Name:SPADY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1456 SANTA CRUZ RD
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6375
Mailing Address - Country:US
Mailing Address - Phone:606-813-6399
Mailing Address - Fax:
Practice Address - Street 1:1456 SANTA CRUZ RD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6375
Practice Address - Country:US
Practice Address - Phone:606-813-6399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02142207Q00000X
NMA-1601-11207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000522078OtherANTHEM BCBS
KY64021421Medicaid
P00665441OtherRR MEDICARE
KY3321162Medicare PIN
3331071Medicare PIN
KYC69171Medicare UPIN
KY64021421Medicaid