Provider Demographics
NPI:1891781480
Name:SPREHE, SAMUEL EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:EDWARD
Last Name:SPREHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1890 W GAUTHIER RD
Mailing Address - Street 2:205
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-7179
Mailing Address - Country:US
Mailing Address - Phone:337-494-5595
Mailing Address - Fax:337-494-5596
Practice Address - Street 1:1890 W GAUTHIER RD
Practice Address - Street 2:205
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-7179
Practice Address - Country:US
Practice Address - Phone:337-494-5595
Practice Address - Fax:337-494-5596
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY39361225500000X
MS20619207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64098056Medicaid
KYA13771Medicare UPIN