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1295719128

NPI Code Detail

MEDICARE: FREDERIC SPIES MD

MEDICARE: FREDERIC SPIES MD

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	207L00000X	Anesthesiology Physician	C5454	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	770119801	OTHER	AR	ARKANSAS BREASTCARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295719128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERIC SPIES MD

Provider Business Mailing Address
First Line	:	PO BOX 1867
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72702-1867
Country	:	US
Telephone Number	:	918-664-9892
Fax Number	:	918-664-2521

Provider Business Practice Location Address
First Line	:	3215 N NORTHHILLS BLVD
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-4424
Country	:	US
Telephone Number	:	918-664-9892
Fax Number	:	918-664-2521

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

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	02/10/2012

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Directions to “ FREDERIC SPIES MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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