Healthcare Provider Details

I. General information

NPI: 1427260652
Provider Name (Legal Business Name): JULIAN RUFFIN SPRAGUE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 BEAUMONT AVE. GIVEN BUILDING E214
BURLINGTON VT
05405
US

IV. Provider business mailing address

19 IRIS LANE
SOUTH BURLINGTON VT
05403
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-8400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number0420011418
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: