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NPI Code Detail

MEDICARE: KEITH IAN GARNET SPOONER

MEDICARE: KEITH IAN GARNET SPOONER
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
1207V00000XObstetrics & Gynecology PhysicianG2229TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100997UOTHERTXBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1407042971
Entity Type Code : Organization
Provider Name (Legal Business Name) : KEITH IAN GARNET SPOONER
Provider Business Mailing Address
First Line : 117 S WILLIAM BARNETT AVE
Second Line : SUITE A
City : CLEVELAND
State : TX
Zip : 77327-4541
Country : US
Telephone Number : 281-593-1660
Fax Number : 281-593-0730
Provider Business Practice Location Address
First Line : 117 S WILLIAM BARNETT AVE
Second Line : SUITE A
City : CLEVELAND
State : TX
Zip : 77327-4541
Country : US
Telephone Number : 281-593-1660
Fax Number : 281-593-0730
Authorized Official
Title or Position : OWNER
Name : DR. KEITH I.G. SPOONER
Credential : M.D.
Telephone Number : 281-593-1660
Provider Enumeration Date : 09/19/2007
Last Update Date : 12/05/2007

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