MEDICARE: MR. GREGORY S SPAYDE PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	99323	MT
2	363A00000X	Physician Assistant	10004767A	IN
3	363A00000X	Physician Assistant	2219	AZ
4	363AS0400X	Surgical Physician Assistant	10004767A	IN

General Provider Information

NPI Number	:	1083608913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GREGORY S SPAYDE PAC

Provider Business Mailing Address
First Line	:	13188 N 103RD DR
Second Line	:	STE 200
City	:	SUN CITY
State	:	AZ
Zip	:	85351-3064
Country	:	US
Telephone Number	:	602-209-1212
Fax Number	:	623-875-8761

Provider Business Practice Location Address
First Line	:	10590 N MERIDIAN ST # 105
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46290-1028
Country	:	US
Telephone Number	:	317-583-7800
Fax Number	:	317-583-7818

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	04/08/2025

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