Basic Information
| Provider Information | |||||||||
| NPI: | 1598708398 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPAETH | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 362 S HARDING RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432091949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6146573422 | ||||||||
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| Practice Location | |||||||||
| Address1: | 265 BROOKVIEW CENTRE WAY STE 400 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379194052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003422898 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 11/18/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35062563S | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 57754. | AZ | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | P00075897 | 01 | HOCKING MEDICARE RR | OTHER | 0917897 | 05 | OH | MEDICAID | 000000315934 | 01 | HOCKING BCBS | OTHER |