Provider Demographics
NPI:1528083466
Name:SPRADLIN, DONALD G (DO)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:G
Last Name:SPRADLIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60545
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80960-0545
Mailing Address - Country:US
Mailing Address - Phone:719-481-6183
Mailing Address - Fax:719-481-2825
Practice Address - Street 1:1415 W CHEYENNE MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-6211
Practice Address - Country:US
Practice Address - Phone:719-481-6183
Practice Address - Fax:719-481-2825
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28978207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01289784Medicaid
COCM3718Medicare PIN
CO01289784Medicaid