Provider Demographics
NPI:1669441671
Name:SPIGENER, SHANNON DAWN (MD)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:DAWN
Last Name:SPIGENER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 GERMANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-1301
Mailing Address - Country:US
Mailing Address - Phone:318-377-8232
Mailing Address - Fax:
Practice Address - Street 1:1111 HOMER RD
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-3027
Practice Address - Country:US
Practice Address - Phone:318-377-7500
Practice Address - Fax:318-377-2324
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.022110207P00000X
LALA022110207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1675130Medicaid
LAG20094Medicare UPIN
LA5W544DF59Medicare PIN
LA1675130Medicaid