Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 1568 | TX |
N | 222Z00000X | Podiatrist | 1568 | TX |
Y | 224P00000X | Prosthetist | 1568 | TX |
NPI | 1316208598 |
---|---|
Provider Name | Micah Spradling |
First Address | Lubbock, TX 79410-2015 |
Second Address | Lubbock, TX 79410-2015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2012 |
Last Update Date | 23/08/2012 |