Provider Demographics
NPI:1902824816
Name:SPUDICK, JEANNE MAIRE (DO)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:MAIRE
Last Name:SPUDICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 SEAHAVEN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT COAST
Mailing Address - State:CA
Mailing Address - Zip Code:92657-1506
Mailing Address - Country:US
Mailing Address - Phone:949-376-8386
Mailing Address - Fax:949-640-0741
Practice Address - Street 1:1441 AVOCADO AVE
Practice Address - Street 2:SUITE 409
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7721
Practice Address - Country:US
Practice Address - Phone:949-640-4501
Practice Address - Fax:949-640-0741
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A6795207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG64344Medicare UPIN