Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | E-5606 | AR |
N | 208600000X | Surgeon | E-5606 | AR |
N | 208200000X | Surgeon | L5552 | TX |
N | 208600000X | Surgeon | L5552 | TX |
Y | 2086S0122X | Plastic and Reconstructive Surgery | E-5606 | AR |
NPI | 1225040447 |
---|---|
Provider Name | Dr. Michael Lee Spann |
First Address | Little Rock, AR 72212 |
Second Address | Little Rock, AR 72212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 24/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I26103 | (02) | TX |