Spondylos Medical Group, Inc.

Primary specialty

Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X

License

G35628 Issued in CA

Legal business name

SPONDYLOS MEDICAL GROUP, INC.

Practice address

4130 La Jolla Village Dr
Suite 300
La Jolla, CA 92037-9121

Phone

(858) 587-0700

Fax

(858) 587-0401

NPI assigned

May 5, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Bruce E. Van Dam, M.D.

Title

President

Phone

(858) 587-0700

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104038587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4130 LA JOLLA VILLAGE DR",
            "address_2": "SUITE 300",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920379121",
            "telephone_number": "858-587-0700",
            "fax_number": "858-587-0401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4130 LA JOLLA VILLAGE DR",
            "address_2": "SUITE 300",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920379121",
            "telephone_number": "858-587-0700",
            "fax_number": "858-587-0401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPONDYLOS MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VAN DAM",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-587-0700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207XS0117X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "CA",
            "license": "G35628",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthopaedic Surgery of the Spine Physician in La Jolla, CA
• Providers in La Jolla, CA by specialty
• Orthopaedic Surgery of the Spine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.