Provider Demographics
NPI:1699778662
Name:SPEDALE, ANTHONY ROLAND JR (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:ROLAND
Last Name:SPEDALE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3113 WESLEY WAY STE 1
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-2004
Mailing Address - Country:US
Mailing Address - Phone:334-699-5123
Mailing Address - Fax:334-699-5125
Practice Address - Street 1:210 WESTSIDE DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-1928
Practice Address - Country:US
Practice Address - Phone:334-793-5074
Practice Address - Fax:334-793-6460
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2020-11-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA24418207R00000X
AL22862207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110221409OtherRAILROAD MEDICARE
AL051550636Medicaid
AL051550636Medicare ID - Type UnspecifiedMEDICARE NUMBER
AL051550636Medicaid