Provider Demographics
NPI:1538206164
Name:SPONSLER, JEFFREY L (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:SPONSLER
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 1:4551 E BOGARD RD
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6075
Mailing Address - Country:US
Mailing Address - Phone:907-373-6500
Mailing Address - Fax:888-456-0663
Practice Address - Street 1:4551 E BOGARD RD
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6075
Practice Address - Country:US
Practice Address - Phone:907-373-6500
Practice Address - Fax:888-456-0663
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5128174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD5128Medicaid
AKMD5128Medicaid
AKI11739Medicare UPIN
AKK153237Medicare ID - Type UnspecifiedGROUP PRACTICE NUMBER