Provider Demographics
NPI:1720029390
Name:SPERLE, GREGORY J (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:SPERLE
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:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:218-732-2800
Mailing Address - Fax:218-732-2874
Practice Address - Street 1:705 PLEASANT AVE S
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1440
Practice Address - Country:US
Practice Address - Phone:218-732-2800
Practice Address - Fax:218-732-2874
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32438207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN13182Medicaid
MN40458SPOtherMNBS #
MN40459SPOtherMNBS #
MN0106878OtherMEDICA #
MN865203OtherAMERICA'S PPO/ARAZ #
MNDA9041000301OtherPREFERRED ONE #
MN0106019OtherMEDICA #
MNHP19562OtherHEALTHPARTNERS #
MN102766OtherUCARE #
MN0106018OtherMEDICA #
MN033790100Medicaid
MN10082OtherNDBS #
MN40460SPOtherMNBS #
MNMN100007OtherLHS/BANNERHEALTH #
MNE91465Medicare UPIN
MNHP19562OtherHEALTHPARTNERS #
MN10082OtherNDBS #
MN102766OtherUCARE #