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NPI Code Detail

MEDICARE: PAUL THOMAS SPORE

MEDICARE: PAUL THOMAS SPORE
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
1390200000XStudent in an Organized Health Care Education/Training ProgramTX

General Provider Information

NPI Number : 1740982321
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL THOMAS SPORE
Provider Business Mailing Address
First Line : 901 W BEN WHITE BLVD
Second Line :
City : AUSTIN
State : TX
Zip : 78704-6903
Country : US
Telephone Number : 512-816-5648
Fax Number :
Provider Business Practice Location Address
First Line : 901 W BEN WHITE BLVD
Second Line :
City : AUSTIN
State : TX
Zip : 78704-6903
Country : US
Telephone Number : 512-816-5648
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2023
Last Update Date : 05/29/2026

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Directions to “ PAUL THOMAS SPORE ” Practice Location

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