Provider Demographics
NPI:1295754406
Name:SPRUTE, DANA (MD)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:
Last Name:SPRUTE
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 1:1601 RIO GRANDE ST STE 348
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1149
Mailing Address - Country:US
Mailing Address - Phone:512-324-8960
Mailing Address - Fax:
Practice Address - Street 1:1313 RED RIVER ST STE 100
Practice Address - Street 2:AUSTIN MEDICAL EDUCATION FAMILY MEDICINE RESIDENCY
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1923
Practice Address - Country:US
Practice Address - Phone:512-324-8600
Practice Address - Fax:512-324-8616
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6741207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132110104Medicaid
TX80069KOtherBCBS ID #
TXF93894Medicare UPIN
TX132110104Medicaid