Provider Demographics
NPI:1447646989
Name:SPANKOVICH, CHRISTOPHER (AUD, PHD, MPH)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:SPANKOVICH
Suffix:
Gender:M
Credentials:AUD, PHD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 NORTH STATE STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-4550
Mailing Address - Fax:601-984-5085
Practice Address - Street 1:2500 NORTH STATE STREET
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-4550
Practice Address - Fax:601-984-5085
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA3968207Y00000X
FLAY1666231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07585560Medicaid
MS423171YJ5DMedicare PIN