MEDICARE: CATHERINE SPONG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VM0101X	Maternal & Fetal Medicine Physician	21260	DC
2	207VX0000X	Obstetrics Physician	0101058227	VA
3	207VM0101X	Maternal & Fetal Medicine Physician	R7603	TX

General Provider Information

NPI Number	:	1518967355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE SPONG MD

Provider Business Mailing Address
First Line	:	UT SOUTHWESTERN MEDICAL CENTER PO BOX 845347
Second Line	:	DEPT OF OB-GYN
City	:	DALLAS
State	:	TX
Zip	:	75390-9032
Country	:	US
Telephone Number	:	214-648-2303
Fax Number	:

Provider Business Practice Location Address
First Line	:	UT SOUTHWESTERN MEDICAL CENTER, DEPT OF OB-GYN
Second Line	:	5323 HARRY HINES BLVD
City	:	DALLAS
State	:	TX
Zip	:	75390-9032
Country	:	US
Telephone Number	:	214-648-3113
Fax Number	:	214-648-7262

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	11/30/2018

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