Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 035725E | PA |
NPI | 1093765919 |
---|---|
Provider Name | John W Spurlock |
First Address | Bethlehem, PA 18018-6336 |
Second Address | Bethlehem, PA 18018-6336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 24/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1704151 | HIGHMARK BLUE SHIELD (01) | PA |
50047463 | CAPITAL BLUE CROSS (01) | PA |
F29457 | (02) | PA |
P00210712 | PALMETTO GBA (01) |