Provider Demographics
NPI:1407899172
Name:JOHN W. SPURLOCK MD PC
Entity Type:Organization
Organization Name:JOHN W. SPURLOCK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:SPURLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-868-5780
Mailing Address - Street 1:433 E BROAD ST
Mailing Address - Street 2:
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA035725E207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F29457OtherUPIN
1704151OtherHIGHMARK BLUE SHIELD
DD1455OtherPALMETTO GBA
50047463OtherCAPITAL BLUE CROSS
1704151OtherHIGHMARK BLUE SHIELD