Individual
TERRY L SPOHR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
229 S. 7TH STREET, ST. MARIES, ID 83861
(208) 245-2591
(208) 245-5246
Mailing address
229 S. 7TH STREET, ST. MARIES, ID 83861
(208) 245-2591
(208) 245-5246
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA28
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002790900
—
ID
01
—
1185830001
MEDICARE DMERC
ID
01
—
970003235
RAILROAD MEDICARE
ID
Enumeration date
05/12/2006
Last updated
11/10/2016
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