=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194876730
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WENDY SPANOS, M.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2007
-----------------------------------------------------
Last Update Date | 07/31/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1107 E MATTHEWS AVE STE 103
-----------------------------------------------------
City | JONESBORO
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72401-4331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-935-0700
-----------------------------------------------------
Fax | 870-935-0706
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1107 E MATTHEWS AVE STE 103
-----------------------------------------------------
City | JONESBORO
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72401-4331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-935-0700
-----------------------------------------------------
Fax | 870-935-0706
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. WENDY L SPANOS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 870-935-0700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------