Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 37474 | KY |
NPI | 1124097597 |
---|---|
Provider Name | Dr. Douglas Sprague |
First Address | Lynn Haven, FL 32444-5048 |
Second Address | Madisonville, KY 42431-1652 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 22/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
26427 | BCBS FLORIDA (01) | FL |
377081800 | (05) | FL |
E90941 | (02) | FL |