Provider Demographics
NPI:1447334867
Name:SPORE, SCOTT STEVEN (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:STEVEN
Last Name:SPORE
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 1:418 N UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-3035
Mailing Address - Country:US
Mailing Address - Phone:806-771-5882
Mailing Address - Fax:806-687-9002
Practice Address - Street 1:418 N UTICA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-3035
Practice Address - Country:US
Practice Address - Phone:806-771-5882
Practice Address - Fax:806-687-9002
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2124208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F5901OtherBLUE CROSS BLUE SHIELD
TX134316208Medicaid
TX124581101OtherFIRSTCARE
TXG45215Medicare UPIN
TX00121QMedicare PIN