MEDICARE: MR. ROBERT C SPURNY SR. 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	207W00000X	Ophthalmology Physician	15705	AZ
2	207WX0009X	Glaucoma Specialist (Ophthalmology) Physician	15705	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0155330	OTHER	AZ	BCBS

General Provider Information

NPI Number	:	1942232798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT C SPURNY SR. MD

Provider Business Mailing Address
First Line	:	6402 E SUPERSTITION SPRINGS BLVD STE 209
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4393
Country	:	US
Telephone Number	:	480-981-3317
Fax Number	:	480-981-5308

Provider Business Practice Location Address
First Line	:	6402 E SUPERSTITION SPRINGS BLVD STE 209
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4393
Country	:	US
Telephone Number	:	480-981-3317
Fax Number	:	480-981-5308

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	02/24/2021

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