Provider Demographics
NPI:1003886714
Name:SPITZER, JEROME S (MD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:S
Last Name:SPITZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 N LORRAINE ST
Mailing Address - Street 2:STE 110
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67501
Mailing Address - Country:US
Mailing Address - Phone:620-663-8484
Mailing Address - Fax:620-663-7031
Practice Address - Street 1:1600 N LORRAINE ST
Practice Address - Street 2:STE 110
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67501
Practice Address - Country:US
Practice Address - Phone:620-663-8484
Practice Address - Fax:620-663-7031
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS0412787207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS103151OtherBLUE CROSS BS
103151Medicare ID - Type Unspecified
B68213Medicare UPIN