Provider Demographics
NPI:1932162591
Name:SPANOS, DEMETRIUS S (MD)
Entity type:Individual
Prefix:DR
First Name:DEMETRIUS
Middle Name:S
Last Name:SPANOS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1107 E MATTHEWS AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4315
Mailing Address - Country:US
Mailing Address - Phone:870-931-4442
Mailing Address - Fax:870-931-4707
Practice Address - Street 1:1107 E MATTHEWS AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4315
Practice Address - Country:US
Practice Address - Phone:870-931-4442
Practice Address - Fax:870-931-4707
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE10362084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C456OtherGROUP MEDICARE
ARG16108Medicare UPIN
AR5C456OtherGROUP MEDICARE