Individual
DR. CEDRIC W. SPAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1025 COLLEGE AVE, FORT WORTH, TX 76104-3013
(817) 810-9810
(817) 840-9815
Mailing address
3300 OAKDALE AVE N, ROBBINSDALE, MN 55422-2926
(763) 520-5200
(763) 257-8356
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
L1206
TX
207RI0200X
Infectious Disease Physician
MD00043412
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145478703
—
TX
01
—
8J4777
MEDICARE
TX
Enumeration date
12/19/2006
Last updated
10/29/2018
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