MEDICARE: DR. JEFFREY EDWARD SPOO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	G85800	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053374694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY EDWARD SPOO M.D.

Provider Business Mailing Address
First Line	:	862 MEINECKE AVE
Second Line	:	SUITE 100
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93405-1721
Country	:	US
Telephone Number	:	805-349-9545
Fax Number	:	805-349-8025

Provider Business Practice Location Address
First Line	:	2342 PROFESSIONAL PKWY
Second Line	:	#200
City	:	SANTA MARIA
State	:	CA
Zip	:	93455-1630
Country	:	US
Telephone Number	:	805-349-9545
Fax Number	:	805-349-8025

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	02/19/2010

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Directions to “ DR. JEFFREY EDWARD SPOO M.D.” Practice Location

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