| Doctor Name: | DR. MICHAEL BRYON SPACKMAN |
| NPI Number: | 1386887032 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 51640 |
| Business Practice Address: | 360 E Montvue Dr Suite 100 Meridian, ID - 836426318 |
| Business Phone Number: | 2088552900 |
| Business Fax Number: | |
| Mailing Address: | 2835 N Tanglerose Pl, EAGLE |
| State: | ID |
| Postal Code: | 836165796 |
| Phone Number: | 9522395080 |
| Fax Number: | |
| NPI Enumeration Date: | 04/10/2009 |
| NPI Last Update Date: | 07/27/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 51640 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |