MEDICARE: PATRICK JACKSON SPALDING 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	207V00000X	Obstetrics & Gynecology Physician	G83816	CA

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

General Provider Information

NPI Number	:	1659454221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK JACKSON SPALDING MD

Provider Business Mailing Address
First Line	:	2 JAMES WAY
Second Line	:	SUITE 106
City	:	PISMO BEACH
State	:	CA
Zip	:	93449-4973
Country	:	US
Telephone Number	:	805-773-3060
Fax Number	:	805-269-0026

Provider Business Practice Location Address
First Line	:	2 JAMES WAY
Second Line	:	SUITE 106
City	:	PISMO BEACH
State	:	CA
Zip	:	93449-4973
Country	:	US
Telephone Number	:	805-773-3060
Fax Number	:	805-269-0026

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/19/2012

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