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General NPI Number Information
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NPI Number | 1104828284
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Entity Type | Individual
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Provider Name | JACK J SPRINGER M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 5555 GROSSMONT CENTER DR
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City | LA MESA
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State | CA
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Zip | 91942-3019
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Country | US
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Telephone | 619-710-4145
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Fax |
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Provider Business Mailing Address
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Address Line | 5841 STRESEMANN ST
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City | SAN DIEGO
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State | CA
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Zip | 92122-3140
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Country | US
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Telephone | 858-243-2186
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Fax | 858-597-0808
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | G70780
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License Number State | CA
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