| Organization Name: | H. SPRAGUE TAVEAU IV DO PA |
| NPI Number: | 1306930250 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HORATIO SPRAGUE TAVEAU (OWNER) |
| Mailing Address: | 2300 S Clear Creek Rd Suite 101 Killeen |
| State: | TX US |
| Postal Code: | 765494984 |
| Phone Number: | 8559634325 |
| Fax Number: | 8559634325 |
| NPI Enumeration Date: | 10/03/2006 |
| NPI Last Update Date: | 05/16/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | J0696 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |