=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407899172
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN W. SPURLOCK MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2006
-----------------------------------------------------
Last Update Date | 07/13/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 433 E BROAD ST
-----------------------------------------------------
City | BETHLEHEM
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18018-6336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-868-5780
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 433 E BROAD ST
-----------------------------------------------------
City | BETHLEHEM
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18018-6336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-868-5780
-----------------------------------------------------
Fax | 610-868-5589
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOHN W SPURLOCK
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 610-868-5780
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number | 035725E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------