Provider Demographics
NPI:1699763078
Name:SPITZER, STUART KEITH (MD)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:KEITH
Last Name:SPITZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 975341
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75397-0001
Mailing Address - Country:US
Mailing Address - Phone:972-932-5559
Mailing Address - Fax:972-932-5581
Practice Address - Street 1:874 ED HALL DR
Practice Address - Street 2:STE. 107
Practice Address - City:KAUFMAN
Practice Address - State:TX
Practice Address - Zip Code:75142-1861
Practice Address - Country:US
Practice Address - Phone:972-932-5559
Practice Address - Fax:972-932-5581
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6740208600000X, 2083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00210901OtherMEDICARE RAILROAD
TX8F3312OtherBLUE SHIELD
TX045579203Medicaid
TX045579202Medicaid
TX8K9466OtherBLUE SHIELD - THG
TX8J2001Medicare PIN
TX8E0186Medicare PIN
TX8K9466OtherBLUE SHIELD - THG