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General NPI Number Information
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NPI Number | 1053329490
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Entity Type | Individual
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Provider Name | ROBERT NEAL SPADY MD
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Gender | Male
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 11/11/2025
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Provider Practice Location Address
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Address Line | 619 S WASHINGTON SUITE 203
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City | MOSCOW
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State | ID
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Zip | 83843
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Country | US
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Telephone | 208-892-1346
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Fax | 208-892-8306
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Provider Business Mailing Address
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Address Line | 619 S WASHINGTON ST STE 203
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City | MOSCOW
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State | ID
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Zip | 83843-3063
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Country | US
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Telephone | 208-892-1346
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Fax | 208-892-8306
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | M5447
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD00032566
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License Number State | WA
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