Provider Demographics
NPI:1356329205
Name:SPOONER, ELIZABETH GOLLADAY (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:GOLLADAY
Last Name:SPOONER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:CAROL
Other - Last Name:GOLLADAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1440 PLEASANT ST STE 1
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-1728
Mailing Address - Country:US
Mailing Address - Phone:515-241-8383
Mailing Address - Fax:
Practice Address - Street 1:1440 PLEASANT ST STE 1
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-1728
Practice Address - Country:US
Practice Address - Phone:515-241-8383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-02
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR3595207VM0101X
IAMD-52347207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX388371204Medicaid