Healthcare Provider Details

I. General information

NPI: 1578944518
Provider Name (Legal Business Name): ZACHARY THOMAS SPRAGUE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2176 SALK AVE
CARLSBAD CA
92008-7346
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 760-827-7210
  • Fax:
Mailing address:
  • Phone: 760-827-7210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A15636
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: