Individual
GLEN F MCSPADDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1101 JACKSON ST SW, GRAVETTE, AR 72736-9121
(479) 787-5291
(479) 344-6404
Mailing address
13763 COLLINE RD, BENTONVILLE, AR 72712-9147
(479) 426-9940
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
24242
OK
207P00000X
Emergency Medicine Physician
Primary
E4542
AR
207Q00000X
Family Medicine Physician
E4542
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200052620A
—
OK
Enumeration date
02/17/2006
Last updated
11/03/2022
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