Organization
H. SPRAGUE TAVEAU IV DO PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HORATIO SPRAGUE TAVEAU IV DO (OWNER)
(855) 963-4325
Entity
Organization
Contact information
Practice address
2300 S CLEAR CREEK RD, SUITE 101, KILLEEN, TX 76549-4984
(855) 963-4325
(855) 963-4325
Mailing address
2300 S CLEAR CREEK RD, SUITE 101, KILLEEN, TX 76549-4984
(855) 963-4325
(855) 963-4325
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
J0696
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
140005324
—
TX
Enumeration date
10/03/2006
Last updated
05/16/2014
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