Provider Demographics
NPI:1316938046
Name:SPRAGUE, MERLE SPENCER (MD)
Entity type:Individual
Prefix:
First Name:MERLE
Middle Name:SPENCER
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 KALAWAO ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1576
Mailing Address - Country:US
Mailing Address - Phone:808-433-6601
Mailing Address - Fax:808-433-3372
Practice Address - Street 1:1 JARRETT WHITE BLVD
Practice Address - Street 2:TRIPLER ARMY MEDICAL CENTER
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96855
Practice Address - Country:US
Practice Address - Phone:808-433-6601
Practice Address - Fax:808-433-3372
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF42072085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology