Provider Demographics
NPI:1700964780
Name:SPANN, CANDACE THORNTON (MD)
Entity Type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:THORNTON
Last Name:SPANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 BOX CANYON DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0450
Mailing Address - Country:US
Mailing Address - Phone:702-998-8486
Mailing Address - Fax:702-998-8282
Practice Address - Street 1:2615 BOX CANYON DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0450
Practice Address - Country:US
Practice Address - Phone:702-998-8486
Practice Address - Fax:702-998-8282
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230915207N00000X
NV13132207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3K4832Medicare ID - Type Unspecified
NVCD987YMedicare PIN
NVCD987ZMedicare PIN