Provider Demographics
NPI:1720269459
Name:SPOONER, JUSTIN KUHNS (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:KUHNS
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 1:230 CANAL BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3745
Mailing Address - Country:US
Mailing Address - Phone:904-280-6701
Mailing Address - Fax:904-280-6702
Practice Address - Street 1:230 CANAL BLVD STE 2
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-3745
Practice Address - Country:US
Practice Address - Phone:904-280-6701
Practice Address - Fax:904-280-6702
Is Sole Proprietor?:No
Enumeration Date:2007-11-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1156252084P0800X, 208VP0014X, 2084P0804X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0086324100Medicaid
FLHG956OtherMEDICARE
FLHG956OtherMEDICARE