Provider Demographics
NPI:1093765919
Name:SPURLOCK, JOHN W (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:SPURLOCK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:433 E BROAD ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-6336
Mailing Address - Country:US
Mailing Address - Phone:610-868-5780
Mailing Address - Fax:610-868-5589
Practice Address - Street 1:433 E BROAD ST
Practice Address - Street 2:UNIT 1
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6336
Practice Address - Country:US
Practice Address - Phone:610-868-5780
Practice Address - Fax:610-868-5589
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2010-05-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PA035725E207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1704151OtherHIGHMARK BLUE SHIELD
P00210712OtherPALMETTO GBA
PA50047463OtherCAPITAL BLUE CROSS
P00210712OtherPALMETTO GBA
PA688392T6KMedicare PIN