MEDICARE: RICHARD G SPURLOCK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	34147	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	008120	OTHER	CO	KAISER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1558498501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD G SPURLOCK MD

Provider Business Mailing Address
First Line	:	1975 RESEARCH PKWY
Second Line	:	STE 250, FLOOR 2
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1025
Country	:	US
Telephone Number	:	303-338-4545
Fax Number	:

Provider Business Practice Location Address
First Line	:	1975 RESEARCH PKWY
Second Line	:	STE 250, FLOOR 2
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1025
Country	:	US
Telephone Number	:	303-338-4545
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	08/15/2012

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