Provider Demographics
NPI:1447330881
Name:SPANN, STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:SPANN
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 1:3701 KIRBY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-3900
Mailing Address - Country:US
Mailing Address - Phone:713-798-7700
Mailing Address - Fax:713-798-7775
Practice Address - Street 1:4849 CALHOUN RD STE 1001A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77204-3900
Practice Address - Country:US
Practice Address - Phone:346-348-1201
Practice Address - Fax:713-481-1730
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE4694207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139117912Medicaid
TX139117912Medicaid
TX080137116Medicare PIN
C86551Medicare UPIN
TX87W144Medicare PIN