Provider Demographics
NPI:1407042971
Name:KEITH IAN GARNET SPOONER
Entity Type:Organization
Organization Name:KEITH IAN GARNET SPOONER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:IG
Authorized Official - Last Name:SPOONER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-593-1660
Mailing Address - Street 1:117 S WILLIAM BARNETT AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77327-4541
Mailing Address - Country:US
Mailing Address - Phone:281-593-1660
Mailing Address - Fax:281-593-0730
Practice Address - Street 1:117 S WILLIAM BARNETT AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-4541
Practice Address - Country:US
Practice Address - Phone:281-593-1660
Practice Address - Fax:281-593-0730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2229207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00997UOtherBLUE CROSS BLUE SHIELD
TX00997UOtherBLUE CROSS BLUE SHIELD
TXB26620Medicare UPIN