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General NPI Number Information
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NPI Number | 1083608913
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Entity Type | Individual
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Provider Name | GREGORY S SPAYDE PAC
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Gender | Male
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Dates
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Enumeration Date | 09/07/2005
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 10590 N MERIDIAN ST # 105
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City | CARMEL
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State | IN
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Zip | 46290-1028
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Country | US
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Telephone | 317-583-7800
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Fax | 317-583-7818
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Provider Business Mailing Address
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Address Line | 13188 N 103RD DR STE 200
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City | SUN CITY
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State | AZ
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Zip | 85351-3064
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Country | US
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Telephone | 602-209-1212
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Fax | 623-875-8761
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 99323
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10004767A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2219
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 10004767A
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License Number State | IN
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