MEDICARE: SPANGLER MEDICAL ENTERPRISES, PA

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	207Q00000X	Family Medicine Physician	L4728	TX

General Provider Information

NPI Number	:	1538347240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPANGLER MEDICAL ENTERPRISES, PA

Provider Business Mailing Address
First Line	:	PO BOX 572
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77574-0572
Country	:	US
Telephone Number	:	281-218-7200
Fax Number	:	281-218-7203

Provider Business Practice Location Address
First Line	:	17000 EL CAMINO REAL STE 201B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-2636
Country	:	US
Telephone Number	:	281-218-7200
Fax Number	:	281-218-7203

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	DR. GARY W SPANGLER JR.
Credential	:	M.D.
Telephone Number	:	281-218-7200

Provider Enumeration Date	:	02/05/2008
Last Update Date	:	02/05/2008

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