Healthcare Provider Details

I. General information

NPI: 1568405330
Provider Name (Legal Business Name): A. DOUGLAS SPITALNY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 02/13/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MCXP-CCS-CR GENERAL LEONARD WOOD COMMUNITY HOSPITAL
FT. LEONARD WOOD MO
65473-1267
US

IV. Provider business mailing address

PO BOX 2546
JOPLIN MO
64803-2546
US

V. Phone/Fax

Practice location:
  • Phone: 573-596-1764
  • Fax:
Mailing address:
  • Phone: 620-783-4441
  • Fax: 620-783-4090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number748
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number748
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: