Provider Demographics
NPI:1477599884
Name:SPRAY, ANGELA J (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:J
Last Name:SPRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7136 S OUTER ROAD 364
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-7756
Mailing Address - Country:US
Mailing Address - Phone:636-561-3277
Mailing Address - Fax:636-561-5280
Practice Address - Street 1:7136 S OUTER ROAD 364
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7756
Practice Address - Country:US
Practice Address - Phone:636-561-3277
Practice Address - Fax:636-561-5280
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004004910207N00000X, 207NS0135X, 207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOI21552Medicare UPIN