Provider Demographics
NPI:1487718144
Name:SPANN, MICHAEL GREGORY (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GREGORY
Last Name:SPANN
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:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:972-233-1999
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:6606 LBJ FWY
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0275207L00000X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100067240AMedicaid
TXP014466772OtherRR
TX126526612Medicaid
TX8EH510OtherBCBS
TX126526612Medicaid
OK100067240AMedicaid
TX259408YK8AMedicare UPIN
TXF41871Medicare UPIN
TN126526608Medicaid
TX126526610Medicaid
TX126526606Medicaid
TX126526611Medicaid
TX259408YK9HMedicare PIN