Provider Demographics
NPI:1063411999
Name:SPADARO, JAMES J JR (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:SPADARO
Suffix:JR
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 1:1050 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-2905
Mailing Address - Country:US
Mailing Address - Phone:573-308-1301
Mailing Address - Fax:573-202-2480
Practice Address - Street 1:1050 W 10TH ST
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2905
Practice Address - Country:US
Practice Address - Phone:573-308-1301
Practice Address - Fax:573-202-2480
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9324207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
10372OtherBC/BS ID#
43-1571021OtherTAX ID#
145792OtherHEALTHLINK ID#
4040796OtherAETNA ID#
MO202587614Medicaid
8712OtherGHP ID#
MO202587622Medicaid
2500043OtherUHC ID#
5512255OtherCIGNA ID#
2500043OtherUHC ID#
5512255OtherCIGNA ID#
MO202587614Medicaid