Basic Information
Provider Information
NPI: 1982679619
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SPANGLER
FirstName: SEAN
MiddleName: ALAN
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 331
Address2:  
City: LIBERTY LAKE
State: WA
PostalCode: 990190331
CountryCode: US
TelephoneNumber: 8667472455
FaxNumber:  
Practice Location
Address1: 122 W 7TH AVE
Address2: STE 450
City: SPOKANE
State: WA
PostalCode: 992042349
CountryCode: US
TelephoneNumber: 5094558820
FaxNumber: 5098384978
Other Information
ProviderEnumerationDate: 02/17/2006
LastUpdateDate: 04/06/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/06/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000XMD00043873WAY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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