Provider Demographics
NPI: | 1164425963 |
---|---|
Name: | SPRAGG, MATTHEW T (DO) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | MATTHEW |
Middle Name: | T |
Last Name: | SPRAGG |
Suffix: | |
Gender: | M |
Credentials: | DO |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 200 HAWKINS DR |
Mailing Address - Street 2: | |
Mailing Address - City: | IOWA CITY |
Mailing Address - State: | IA |
Mailing Address - Zip Code: | 52242-1009 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 319-384-6562 |
Mailing Address - Fax: | 319-353-7006 |
Practice Address - Street 1: | 200 HAWKINS DR |
Practice Address - Street 2: | |
Practice Address - City: | IOWA CITY |
Practice Address - State: | IA |
Practice Address - Zip Code: | 52242-1009 |
Practice Address - Country: | US |
Practice Address - Phone: | 319-384-6562 |
Practice Address - Fax: | 319-353-7006 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-05-24 |
Last Update Date: | 2012-05-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 2004-01333 | 207P00000X |
IA | 4155 | 207P00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | 1378A | Other | MATTHEW SPRAGG'S BCBS # |
NC | 891378A | Medicaid | |
NC | P00184254 | Other | MATTHEW SPRAGG'S RRMCA # |
NC | I09595 | Medicare UPIN | |
NC | P00184254 | Other | MATTHEW SPRAGG'S RRMCA # |