Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 100 | SD |
NPI | 1245280643 |
---|---|
Provider Name | Dr. Judd Alan Sparagon |
First Address | Rapid City, SD 57709-7533 |
Second Address | Fort Meade, SD 57741-1002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 08/07/2007 |