Provider Demographics
NPI:1861487001
Name:SPANN, SCOTT WEAVER (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:WEAVER
Last Name:SPANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5656 BEE CAVES RD
Mailing Address - Street 2:SUITE K-200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5280
Mailing Address - Country:US
Mailing Address - Phone:512-329-6644
Mailing Address - Fax:512-891-6399
Practice Address - Street 1:5656 BEE CAVES RD
Practice Address - Street 2:SUITE K-200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5280
Practice Address - Country:US
Practice Address - Phone:512-329-6644
Practice Address - Fax:512-891-6399
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1685207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096980002Medicaid
TX84090XOtherBC/BS
TX84090XOtherBC/BS
TX8B7057Medicare PIN