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1699778662

NPI Code Detail

MEDICARE: DR. ANTHONY ROLAND SPEDALE JR. MD

MEDICARE: DR. ANTHONY ROLAND SPEDALE JR. 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	207R00000X	Internal Medicine Physician	24418	LA
2	207R00000X	Internal Medicine Physician	22862	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110221409	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699778662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY ROLAND SPEDALE JR. MD

Provider Business Mailing Address
First Line	:	3113 WESLEY WAY STE 1
Second Line	:
City	:	DOTHAN
State	:	AL
Zip	:	36305-2004
Country	:	US
Telephone Number	:	334-699-5123
Fax Number	:	334-699-5125

Provider Business Practice Location Address
First Line	:	210 WESTSIDE DR
Second Line	:
City	:	DOTHAN
State	:	AL
Zip	:	36303-1928
Country	:	US
Telephone Number	:	334-793-5074
Fax Number	:	334-793-6460

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	11/06/2020

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Directions to “ DR. ANTHONY ROLAND SPEDALE JR. MD” Practice Location

Language	Start Address	Practice Location

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