Provider Demographics
NPI:1952497695
Name:SPRUNG, ROMA J (MD)
Entity Type:Individual
Prefix:
First Name:ROMA
Middle Name:J
Last Name:SPRUNG
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 1:560 CATALINA DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1605
Mailing Address - Country:US
Mailing Address - Phone:541-201-4800
Mailing Address - Fax:541-201-4815
Practice Address - Street 1:560 CATALINA DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1605
Practice Address - Country:US
Practice Address - Phone:541-201-4800
Practice Address - Fax:541-201-4815
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18746207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORE45111Medicare UPIN