MEDICARE: STUART KEITH SPITZER 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	208600000X	Surgery Physician	J6740	TX
2	2083A0300X	Addiction Medicine (Preventive Medicine) Physician	J6740	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00210901	OTHER	TX	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	8F3312	OTHER	TX	BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	8K9466	OTHER	TX	BLUE SHIELD - THG

General Provider Information

NPI Number	:	1699763078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STUART KEITH SPITZER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 975341
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75397-0001
Country	:	US
Telephone Number	:	972-932-5559
Fax Number	:	972-932-5581

Provider Business Practice Location Address
First Line	:	874 ED HALL DR
Second Line	:	STE. 107
City	:	KAUFMAN
State	:	TX
Zip	:	75142-1861
Country	:	US
Telephone Number	:	972-932-5559
Fax Number	:	972-932-5581

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

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	01/26/2024

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Directions to “ STUART KEITH SPITZER M.D.” Practice Location

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