Provider Demographics
NPI:1891803417
Name:SPOONER, CHRISTOPHER EARL (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:EARL
Last Name:SPOONER
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:P.O. BOX 121
Mailing Address - Street 2:
Mailing Address - City:BISBEE
Mailing Address - State:AZ
Mailing Address - Zip Code:85603
Mailing Address - Country:US
Mailing Address - Phone:520-366-0335
Mailing Address - Fax:
Practice Address - Street 1:1123 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4303
Practice Address - Country:US
Practice Address - Phone:520-366-0335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19439207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ044652Medicare ID - Type Unspecified
AZE49468Medicare UPIN
AZWCLFT02Medicare ID - Type Unspecified