Provider Demographics
NPI:1265679666
Name:MARK S SPITZER D O
Entity type:Organization
Organization Name:MARK S SPITZER D O
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:SPITZER
Authorized Official - Suffix:
Authorized Official - Credentials:D O
Authorized Official - Phone:209-722-9272
Mailing Address - Street 1:PO BOX 3797
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95344-3797
Mailing Address - Country:US
Mailing Address - Phone:209-722-9272
Mailing Address - Fax:209-724-9329
Practice Address - Street 1:410 E YOSEMITE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-8220
Practice Address - Country:US
Practice Address - Phone:209-722-9272
Practice Address - Fax:209-724-9329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ55645YOtherBLUE SHIELD OF CALIFORNIA
CABJ729Medicare PIN