Provider Demographics
NPI:1780761320
Name:SPRUCE, WAYNE ELLSWORTH (MD)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:ELLSWORTH
Last Name:SPRUCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2870 DOVE TAIL DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-0933
Mailing Address - Country:US
Mailing Address - Phone:760-290-3678
Mailing Address - Fax:
Practice Address - Street 1:6160 MISSION GORGE RD
Practice Address - Street 2:SUITE 400
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-3410
Practice Address - Country:US
Practice Address - Phone:619-528-4010
Practice Address - Fax:619-528-4077
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA240222080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A240220Medicaid