Provider Demographics
NPI:1972761823
Name:SPELLMAN, JOHN RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RAYMOND
Last Name:SPELLMAN
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 1:4218-M ARENDELL STREET
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-2871
Mailing Address - Country:US
Mailing Address - Phone:252-808-4250
Mailing Address - Fax:252-808-3120
Practice Address - Street 1:4218-M ARENDELL STREET
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-2871
Practice Address - Country:US
Practice Address - Phone:252-808-4250
Practice Address - Fax:252-808-3120
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-01627174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist