Provider Demographics
NPI:1144260449
Name:SPURLOCK, CORY S (MD)
Entity type:Individual
Prefix:DR
First Name:CORY
Middle Name:S
Last Name:SPURLOCK
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 1:1700 W PARKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2907
Mailing Address - Country:US
Mailing Address - Phone:954-632-8290
Mailing Address - Fax:
Practice Address - Street 1:25548 THE OLD RD
Practice Address - Street 2:
Practice Address - City:STEVENSON RANCH
Practice Address - State:CA
Practice Address - Zip Code:91381-1705
Practice Address - Country:US
Practice Address - Phone:661-556-9020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKC152251207P00000X
CAC152251207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200007590AMedicaid
OK200007590AMedicaid
OKI02849Medicare UPIN