Provider Demographics
NPI:1770661704
Name:SPURLING, JASON K (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:K
Last Name:SPURLING
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 1100
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-1100
Mailing Address - Country:US
Mailing Address - Phone:417-255-8645
Mailing Address - Fax:417-255-8649
Practice Address - Street 1:1307 PORTER WAGONER BLVD
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-1828
Practice Address - Country:US
Practice Address - Phone:417-255-8645
Practice Address - Fax:417-255-8649
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002014471207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO678193OtherHEALTHLINK
MO193410OtherBLUE CROSS BLUE SHIELD
MO200398006Medicaid
MOH82838Medicare UPIN
MO000090153Medicare ID - Type Unspecified