MEDICARE: DR. JOHN ARTHUR VANSPEYBROECK 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	208600000X	Surgery Physician	G028829	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	:	1497832190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ARTHUR VANSPEYBROECK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1155
Second Line	:
City	:	ARCATA
State	:	CA
Zip	:	95518-1155
Country	:	US
Telephone Number	:	707-443-2248
Fax Number	:	707-443-4847

Provider Business Practice Location Address
First Line	:	2321 HARRISON AVE
Second Line	:
City	:	EUREKA
State	:	CA
Zip	:	95501-3216
Country	:	US
Telephone Number	:	707-443-2248
Fax Number	:	707-443-4847

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	05/09/2008

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