Provider Demographics
NPI:1881701407
Name:SPADY, GEORGE P (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:P
Last Name:SPADY
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 1:43977 STERLING HWY
Mailing Address - Street 2:SUITE G
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-8028
Mailing Address - Country:US
Mailing Address - Phone:855-436-7723
Mailing Address - Fax:
Practice Address - Street 1:43977 STERLING HWY
Practice Address - Street 2:SUITE G
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-8028
Practice Address - Country:US
Practice Address - Phone:855-436-7723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD15677207R00000X
AK6888208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000BKFSKMedicare PIN
AKK165503Medicare PIN
AKK163362Medicare PIN
ORE59377Medicare UPIN