MEDICARE: DR. WAYNE ELLSWORTH SPRUCE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0207X	Pediatric Hematology & Oncology Physician	A24022	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780761320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE ELLSWORTH SPRUCE MD

Provider Business Mailing Address
First Line	:	2870 DOVE TAIL DR
Second Line	:
City	:	SAN MARCOS
State	:	CA
Zip	:	92078-0933
Country	:	US
Telephone Number	:	760-290-3678
Fax Number	:

Provider Business Practice Location Address
First Line	:	6160 MISSION GORGE RD
Second Line	:	SUITE 400
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-3410
Country	:	US
Telephone Number	:	619-528-4010
Fax Number	:	619-528-4077

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/13/2011

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