Healthcare Provider Details

I. General information

NPI: 1093765919
Provider Name (Legal Business Name): JOHN W SPURLOCK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 E BROAD ST UNIT 1
BETHLEHEM PA
18018-6336
US

IV. Provider business mailing address

433 E BROAD ST UNIT 1
BETHLEHEM PA
18018-6336
US

V. Phone/Fax

Practice location:
  • Phone: 610-868-5780
  • Fax: 610-868-5589
Mailing address:
  • Phone: 610-868-5780
  • Fax: 610-868-5589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number035725E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: