Basic Information
| Provider Information | |||||||||
| NPI: | 1952455412 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPRANGERS | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 W GRANADA BLVD #4 | ||||||||
| Address2: | |||||||||
| City: | ORMOND BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3866769690 | ||||||||
| FaxNumber: | 3866765418 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 W GRANADA BLVD #4 | ||||||||
| Address2: | |||||||||
| City: | ORMOND BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3866769690 | ||||||||
| FaxNumber: | 3866765418 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207Q00000X | ME93784 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.