MEDICARE: DR. SCOTT D. SPOOR M.D.

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	2084N0400X	Neurology Physician	G8433	TX

General Provider Information

NPI Number	:	1114050143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT D. SPOOR M.D.

Provider Business Mailing Address
First Line	:	PO BOX 162230
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78716-2230
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6101 E OLTORF ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78741-7500
Country	:	US
Telephone Number	:	512-437-8729
Fax Number	:

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	07/08/2007

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