Basic Information
| Provider Information | |||||||||
| NPI: | 1558305342 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPRAGUE | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2200 | ||||||||
| Address2: | |||||||||
| City: | AMHERST | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030314200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036739411 | ||||||||
| FaxNumber: | 6036739899 | ||||||||
| Practice Location | |||||||||
| Address1: | 3601 SW 160TH AVE | ||||||||
| Address2: | SUITE #250 | ||||||||
| City: | MIRAMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330276308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058667123 | ||||||||
| FaxNumber: | 8772848933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 03/02/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 58455 | MA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207Q00000X | 58455 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 058455 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 2323 | 01 | MA | HARVARD PILGRIM | OTHER | 30006726 | 05 | NH | MEDICAID | 3115933 | 05 | MA | MEDICAID | 29753 | 01 | MA | UNICARE | OTHER | 0484640 | 01 | MA | AETNA | OTHER | 168260 | 01 | MA | CIGNA | OTHER | 986224 | 01 | MA | NETWORK HEALTH | OTHER | 23898 | 01 | FALLON COMMUNITY HEALTH | OTHER | J30159 | 01 | MA | BLUE CROSS BLUE SHIELD | OTHER |