Healthcare Provider Details

I. General information

NPI: 1093039521
Provider Name (Legal Business Name): CHAD ALAN SPAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 S ROYLE RD STE 120
RIDGEFIELD WA
98642-7759
US

IV. Provider business mailing address

3745 W 4700 S
SALT LAKE CITY UT
84129
US

V. Phone/Fax

Practice location:
  • Phone: 360-487-1086
  • Fax: 360-487-1088
Mailing address:
  • Phone: 801-840-2100
  • Fax: 801-840-2139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number81373561205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD70043786
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: