Doctor Name: | DR. JUDD ALAN SPARAGON |
NPI Number: | 1245280643 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.P.M. |
License Number: | 100 |
Business Practice Address: | 113 Comanche Rd Fort Meade, SD - 577411002 |
Business Phone Number: | 6053472511 |
Business Fax Number: | 6057207238 |
Mailing Address: | Po Box 7533, RAPID CITY |
State: | SD |
Postal Code: | 577097533 |
Phone Number: | 6053472511 |
Fax Number: | 6057207238 |
NPI Enumeration Date: | 05/10/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213EP1101X |
License Number: | 100 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SD |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Primary Podiatric Medicine |
Taxonomy Definition: |