Provider Demographics
NPI:1821171166
Name:SPOONER, KEITH IG (MD)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:IG
Last Name:SPOONER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:108 S WILLIAM BARNETT AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77327-4542
Mailing Address - Country:US
Mailing Address - Phone:281-659-2355
Mailing Address - Fax:281-592-1570
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:77327-4542
Practice Address - Country:US
Practice Address - Phone:281-593-1660
Practice Address - Fax:281-593-0730
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG2229207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0948168OtherAETNA
TX76-0309941OtherUNITED HEALTHCARE
TX8A6479OtherBLUE CROSS BLUE SHEILD
TX159830201Medicaid
TX63701476OtherCIGNA
TX76-0309941OtherUNITED HEALTHCARE