MEDICARE: JOHN RAYMOND SPELLMAN 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	174400000X	Specialist	2014-01627	NC

General Provider Information

NPI Number	:	1972761823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN RAYMOND SPELLMAN MD

Provider Business Mailing Address
First Line	:	4218-M ARENDELL STREET
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-2871
Country	:	US
Telephone Number	:	252-808-4250
Fax Number	:	252-808-3120

Provider Business Practice Location Address
First Line	:	4218-M ARENDELL STREET
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-2871
Country	:	US
Telephone Number	:	252-808-4250
Fax Number	:	252-808-3120

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

Provider Enumeration Date	:	05/28/2008
Last Update Date	:	08/15/2014

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