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General NPI Number Information
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NPI Number | 1255314837
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Entity Type | Individual
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Provider Name | ROBERT F. SPRUNG JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/28/2005
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Last Update Date | 03/06/2015
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Provider Practice Location Address
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Address Line | 2700 FARMINGTON AVE. BUILDING I, SUITE 2
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City | FARMINGTON
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State | NM
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Zip | 87401-1202
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Country | US
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Telephone | 505-326-3691
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Fax | 505-327-9688
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Provider Business Mailing Address
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Address Line | PO BOX 2769
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City | FARMINGTON
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State | NM
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Zip | 87499-4559
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Country | US
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Telephone | 505-326-3697
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Fax | 505-327-9688
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD2008-0311
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License Number State | NM
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