Healthcare Provider Details

I. General information

NPI: 1841258175
Provider Name (Legal Business Name): MICHAEL WILLIAM SPAGNUOLO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N HIGHLAND AVE STE 415
SHERMAN TX
75092-7390
US

IV. Provider business mailing address

1908 N LAURENT ST STE 410
VICTORIA TX
77901-5469
US

V. Phone/Fax

Practice location:
  • Phone: 903-892-3696
  • Fax: 903-893-9514
Mailing address:
  • Phone: 361-572-0333
  • Fax: 361-371-7090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5101015054
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberP5305
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: