Healthcare Provider Details

I. General information

NPI: 1487656179
Provider Name (Legal Business Name): YVONNE I SPURLOCK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 02/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 GLENN HENDREN DRIVE
LIBERTY MO
64068-4205
US

IV. Provider business mailing address

PO BOX 219672
KANSAS CITY MO
64121-9672
US

V. Phone/Fax

Practice location:
  • Phone: 816-781-7730
  • Fax: 816-415-1886
Mailing address:
  • Phone: 816-781-7730
  • Fax: 816-415-1886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO118406
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: