Doctor Name: | DR. JADE SPURGEON |
NPI Number: | 1154314086 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | 91939 |
Business Practice Address: | 300 Twining St Building 760 Maxwell Afb, AL - 361126027 |
Business Phone Number: | 3349539334 |
Business Fax Number: | |
Mailing Address: | 7919 Falstaff Rd, MC LEAN |
State: | VA |
Postal Code: | 221022726 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 08/25/2005 |
NPI Last Update Date: | 08/12/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 91939 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |