Healthcare Provider Details

I. General information

NPI: 1396936282
Provider Name (Legal Business Name): DANIEL ROBERT SPURGEON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 10/25/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 W SUNSET BLVD 4TH FLOOR
LOS ANGELES CA
90027-5822
US

IV. Provider business mailing address

1426 N EDGEMONT ST APT #10
LOS ANGELES CA
90027-5942
US

V. Phone/Fax

Practice location:
  • Phone: 323-783-7898
  • Fax:
Mailing address:
  • Phone: 323-422-8341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA99921
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: