Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 20A9497 | CA |
N | 207QS0010X | Family Doctor - Sports Medicine | 20A9497 | CA |
NPI | 1114011459 |
---|---|
Provider Name | Jason Edward Spring |
First Address | San Diego, CA 92101-2303 |
Second Address | San Diego, CA 92127 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 09/11/2017 |