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1275505182

NPI Code Detail

MEDICARE: JON A SPAR MD

MEDICARE: JON A SPAR MD

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	2085R0204X	Vascular & Interventional Radiology Physician	85-291	NM
2	2085R0202X	Diagnostic Radiology Physician	85-291	NM

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00218005	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	PROVP16183	OTHER	NM	MOLINA
3	201009513	OTHER	NM	PRESBYTERIAN HEALTH/SALUD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	NM009U95	OTHER	NM	BCBS
6	10001634	OTHER	NM	LOVELACE HEALTH/SALUD
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275505182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JON A SPAR MD

Provider Business Mailing Address
First Line	:	12687 W CEDAR DR
Second Line	:	200
City	:	LAKEWOOD
State	:	CO
Zip	:	80228-2014
Country	:	US
Telephone Number	:	303-468-1395
Fax Number	:	303-468-1394

Provider Business Practice Location Address
First Line	:	1397 WEIMER RD
Second Line	:
City	:	TAOS
State	:	NM
Zip	:	87571-6253
Country	:	US
Telephone Number	:	575-758-8883
Fax Number	:	303-468-1394

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

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	01/02/2020

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Directions to “ JON A SPAR MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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