Healthcare Provider Details

I. General information

NPI: 1194881748
Provider Name (Legal Business Name): LUTHER D. SPURLOCK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W 10TH ST SUITE 160
ROLLA MO
65401-2937
US

IV. Provider business mailing address

PO BOX 2580
SPRINGFIELD MO
65801-2580
US

V. Phone/Fax

Practice location:
  • Phone: 573-341-3043
  • Fax: 573-341-5208
Mailing address:
  • Phone: 417-829-4620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number107151
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: