Provider Demographics
NPI:1669713285
Name:MONROE A SPRAGUE MD INC
Entity type:Organization
Organization Name:MONROE A SPRAGUE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MONROE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPRAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-342-2411
Mailing Address - Street 1:135 MISSION RANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2175
Mailing Address - Country:US
Mailing Address - Phone:530-342-2411
Mailing Address - Fax:530-894-5783
Practice Address - Street 1:135 MISSION RANCH BLVD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2175
Practice Address - Country:US
Practice Address - Phone:530-342-2411
Practice Address - Fax:530-894-5783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39757207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA17460499693Medicaid