Provider Demographics
NPI:1720082431
Name:SPRADLIN, TIMOTHY L (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:L
Last Name:SPRADLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W DEAN KEETON ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78712-1091
Mailing Address - Country:US
Mailing Address - Phone:124-758-2355
Mailing Address - Fax:512-475-9693
Practice Address - Street 1:100 W DEAN KEETON ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-1091
Practice Address - Country:US
Practice Address - Phone:512-475-8235
Practice Address - Fax:512-475-9693
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0616207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
7632216OtherAETNA
ARBS6062854OtherDEA NUMBER
LA1632236Medicaid
7334694003OtherCIGNA
P00158769OtherRAILROAD MEDICARE
MS04627089Medicaid
AR5K951OtherBLUE CROSS/BLUE SHIELD
AR04080021400OtherQUALCHOICE
AR13621001Medicaid
AR2016035OtherUNITED HEALTHCARE
MS04627089Medicaid
AR5K9517231Medicare PIN