Basic Information
| Provider Information | |||||||||
| NPI: | 1790017069 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPIEGEL | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | K. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | HCR 61 BOX 30 | ||||||||
| Address2: | JCT US HWY 160 & NR 35 - RED MESA | ||||||||
| City: | TEECNOSPOS | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286565000 | ||||||||
| FaxNumber: | 9286565164 | ||||||||
| Practice Location | |||||||||
| Address1: | HCR 61 BOX 30 | ||||||||
| Address2: | JCT US HWY 160 & NR 35 - RED MESA | ||||||||
| City: | TEECNOSPOS | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286565000 | ||||||||
| FaxNumber: | 9286565164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2010 | ||||||||
| LastUpdateDate: | 04/19/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 45341 | GA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | 45341 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 70905266 | 05 | NM | MEDICAID | 501990 | 05 | AZ | MEDICAID | 30508568 | 05 | CO | MEDICAID |