Provider Demographics
NPI:1063434132
Name:SPITZ, BRADLEY LAWRENCE (MD)
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:LAWRENCE
Last Name:SPITZ
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 1:501 WASHINGTON ST
Mailing Address - Street 2:STE 508
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2231
Mailing Address - Country:US
Mailing Address - Phone:619-299-2570
Mailing Address - Fax:619-294-2738
Practice Address - Street 1:501 WASHINGTON ST
Practice Address - Street 2:STE 508
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2231
Practice Address - Country:US
Practice Address - Phone:619-299-2570
Practice Address - Fax:619-294-2738
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54360207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A543600Medicaid
CAA54360Medicare ID - Type Unspecified
CA00A543600Medicaid