Provider Demographics
NPI:1306956453
Name:SPRUNGER, LEWIS W (MD)
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:W
Last Name:SPRUNGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 NW EASTMAN PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3858
Mailing Address - Country:US
Mailing Address - Phone:503-571-0725
Mailing Address - Fax:
Practice Address - Street 1:1550 NW EASTMAN PKWY
Practice Address - Street 2:100
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3858
Practice Address - Country:US
Practice Address - Phone:503-571-0725
Practice Address - Fax:503-571-0720
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD134782084P0804X
WAMD000357312084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry