Provider Demographics
NPI:1255545752
Name:SPINKS, SHAUN R (MD)
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:R
Last Name:SPINKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11111 PARK PLACE DR STE B
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70818-3200
Mailing Address - Country:US
Mailing Address - Phone:225-333-3630
Mailing Address - Fax:225-333-3660
Practice Address - Street 1:11111 PARK PLACE DR STE B
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70818-3200
Practice Address - Country:US
Practice Address - Phone:225-333-3630
Practice Address - Fax:225-333-3660
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA324773207Q00000X
TXN1902207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160970OtherSUPERIOR
TX9123391OtherAETNA
TX202743501Medicaid
TX144831802OtherGROUP TEXAS HEALTH STEPS
TX8B5727OtherINDIVIDUAL BLUE CROSS BLUE SHIELD
TX9123391OtherAETNA