Provider Demographics
NPI:1487869293
Name:SPENCER SCHUP, KIMBERLY ANN (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:SPENCER SCHUP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:SCHUP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3106 50TH ST
Mailing Address - Street 2:STE. 400
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-4132
Mailing Address - Country:US
Mailing Address - Phone:806-698-8088
Mailing Address - Fax:806-698-8588
Practice Address - Street 1:3106 50TH ST
Practice Address - Street 2:STE. 400
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-4132
Practice Address - Country:US
Practice Address - Phone:806-698-8088
Practice Address - Fax:806-698-8588
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6739208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ6739OtherMEDICAL LICENSE