Healthcare Provider Details

I. General information

NPI: 1295754406
Provider Name (Legal Business Name): DANA SPRUTE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 RED RIVER ST STE 100 AUSTIN MEDICAL EDUCATION FAMILY MEDICINE RESIDENCY
AUSTIN TX
78701-1923
US

IV. Provider business mailing address

1601 RIO GRANDE ST STE 348
AUSTIN TX
78701-1149
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-8600
  • Fax: 512-324-8616
Mailing address:
  • Phone: 512-324-8960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberJ6741
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: