Provider Demographics
NPI:1659310555
Name:DONALD SPRAGUE MD PA
Entity Type:Organization
Organization Name:DONALD SPRAGUE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-554-8848
Mailing Address - Street 1:3 PROFESSIONAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4123
Mailing Address - Country:US
Mailing Address - Phone:281-554-8848
Mailing Address - Fax:281-554-3348
Practice Address - Street 1:3 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4123
Practice Address - Country:US
Practice Address - Phone:281-554-8848
Practice Address - Fax:281-554-3348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE11392083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00494YMedicare PIN