Provider Demographics
NPI:1982713848
Name:MELINDA D SPOONER MD PA
Entity type:Organization
Organization Name:MELINDA D SPOONER MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SPOONER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-612-5551
Mailing Address - Street 1:3801 W 15TH ST
Mailing Address - Street 2:SUITE 270
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-4737
Mailing Address - Country:US
Mailing Address - Phone:972-964-5514
Mailing Address - Fax:972-312-1476
Practice Address - Street 1:3801 W 15TH ST
Practice Address - Street 2:SUITE 270
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-4737
Practice Address - Country:US
Practice Address - Phone:972-964-5514
Practice Address - Fax:972-312-1476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2379207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK2379OtherPROVIDER STATE LICENSE
0072106Medicare UPIN