Provider Demographics
NPI:1528145695
Name:SPANN, ERIC G (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:G
Last Name:SPANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2580
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:417-829-4316
Practice Address - Street 1:19797 HIGHWAY 5
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:AR
Practice Address - Zip Code:72560-9299
Practice Address - Country:US
Practice Address - Phone:870-269-4144
Practice Address - Fax:870-269-5723
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0234207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207733510Medicaid
AR125539001Medicaid
AR5J468OtherAR BLUE SHIELD #
AR5J468Medicare ID - Type UnspecifiedAR MDCR #
AR125539001Medicaid