Healthcare Provider Details

I. General information

NPI: 1841298429
Provider Name (Legal Business Name): JOHN D SPROED I M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/15/2006
Reactivation Date: 03/29/2006

III. Provider practice location address

868 NW GARDEN VALLEY BLVD
ROSEBURG OR
97470-1959
US

IV. Provider business mailing address

2156 FISHER RD
ROSEBURG OR
97470-9216
US

V. Phone/Fax

Practice location:
  • Phone: 541-492-5433
  • Fax: 541-672-6384
Mailing address:
  • Phone: 541-673-4513
  • Fax: 541-673-3116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD6562
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: