Provider Demographics
NPI:1003131012
Name:SPRUNT, JULIE MCKENZIE (MD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MCKENZIE
Last Name:SPRUNT
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:901 W 38TH ST STE 300
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1166
Practice Address - Country:US
Practice Address - Phone:512-421-4100
Practice Address - Fax:512-419-0924
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1-0036594208600000X
TXQ0571208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX360213801Medicaid
TX360213802Medicaid
TX513383YK4EMedicare PIN
TX360213802Medicaid