Provider Demographics
NPI:1497832190
Name:VANSPEYBROECK, JOHN ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ARTHUR
Last Name:VANSPEYBROECK
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:PO BOX 1155
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95518-1155
Mailing Address - Country:US
Mailing Address - Phone:707-443-2248
Mailing Address - Fax:707-443-4847
Practice Address - Street 1:2321 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3216
Practice Address - Country:US
Practice Address - Phone:707-443-2248
Practice Address - Fax:707-443-4847
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG028829208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G288290Medicaid
CA00G288290Medicare ID - Type Unspecified
CAA43875Medicare UPIN