Healthcare Provider Details

I. General information

NPI: 1003986050
Provider Name (Legal Business Name): THOMAS DUANE SPOONHOUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 03/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8051 W. CENTER ROAD
OMAHA NE
68124
US

IV. Provider business mailing address

1040 N BELL ST
FREMONT NE
68025-4347
US

V. Phone/Fax

Practice location:
  • Phone: 402-391-3333
  • Fax: 402-391-8593
Mailing address:
  • Phone: 402-727-7990
  • Fax: 402-727-1761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number14388
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: