Provider Demographics
NPI:1982758678
Name:SPOONAMORE, MARK J (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:SPOONAMORE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1520 SAN PABLO ST
Mailing Address - Street 2:#2000
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-5310
Mailing Address - Country:US
Mailing Address - Phone:323-442-5300
Mailing Address - Fax:323-442-5301
Practice Address - Street 1:1520 SAN PABLO ST
Practice Address - Street 2:#2000
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-4500
Practice Address - Country:US
Practice Address - Phone:323-442-5300
Practice Address - Fax:323-442-5301
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2013-12-05
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Provider Licenses
StateLicense IDTaxonomies
CAA71130207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H11334Medicare UPIN
CAWA71130CMedicare PIN