MEDICARE: MS. DENISE CARO SPRAGUE R.D., C.D.E.

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	133V00000X	Registered Dietitian	DT02410	TX

General Provider Information

NPI Number	:	1831171818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DENISE CARO SPRAGUE R.D., C.D.E.

Provider Business Mailing Address
First Line	:	3851 ROGER BROOKE DR
Second Line	:	BROOKE ARMY MEDICAL CENTER, MCHE-QD CREDENTIALS
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78232-6299
Country	:	US
Telephone Number	:	210-916-5974
Fax Number	:	210-916-2077

Provider Business Practice Location Address
First Line	:	3851 ROGER BROOKE DR
Second Line	:	BROOKE ARMY MEDICAL CENTER, MCHE-QD CREDENTIALS
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78232-6299
Country	:	US
Telephone Number	:	210-916-5974
Fax Number	:	210-916-2077

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

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	07/08/2007

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