Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 73581 | MA |
N | 207RI0200X | Infectious Disease | 73581 | MA |
NPI | 1194715292 |
---|---|
Provider Name | Robert L. Spangler |
First Address | Gardner, MA 01440 |
Second Address | Gardner, MA 01440 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2005 |
Last Update Date | 10/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E73659 | (02) | |
J1067401 | (02) | MA |