Provider Demographics
NPI:1063401305
Name:SPOONEMORE, KERRIE J (MD)
Entity type:Individual
Prefix:DR
First Name:KERRIE
Middle Name:J
Last Name:SPOONEMORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3216 NE 45TH PL
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4093
Mailing Address - Country:US
Mailing Address - Phone:205-525-1168
Mailing Address - Fax:206-525-1169
Practice Address - Street 1:3216 NE 45TH PL
Practice Address - Street 2:SUITE 203
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4093
Practice Address - Country:US
Practice Address - Phone:205-525-1168
Practice Address - Fax:206-525-1169
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00044804207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8433757Medicaid
WA8433757Medicaid
WAI36583Medicare UPIN