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NPI Code Detail

MEDICARE: DR. JACK J SPRINGER M.D.

MEDICARE: DR. JACK J SPRINGER 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
1207P00000XEmergency Medicine PhysicianG70780CA

Other Identifiers

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

General Provider Information

NPI Number : 1104828284
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACK J SPRINGER M.D.
Provider Business Mailing Address
First Line : 5841 STRESEMANN ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92122-3140
Country : US
Telephone Number : 858-243-2186
Fax Number : 858-597-0808
Provider Business Practice Location Address
First Line : 5555 GROSSMONT CENTER DR
Second Line :
City : LA MESA
State : CA
Zip : 91942-3019
Country : US
Telephone Number : 619-710-4145
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2005
Last Update Date : 05/27/2008

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Directions to “ DR. JACK J SPRINGER M.D.” Practice Location

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