Provider Demographics
NPI:1053664615
Name:PENDER, DONALD SPRAGUE
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:SPRAGUE
Last Name:PENDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 NE 93RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2828
Mailing Address - Country:US
Mailing Address - Phone:786-298-6639
Mailing Address - Fax:954-730-2337
Practice Address - Street 1:3920 NW 49TH ST
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33309-3308
Practice Address - Country:US
Practice Address - Phone:954-730-2333
Practice Address - Fax:954-730-2337
Is Sole Proprietor?:No
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRP1432085R0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0205XAllopathic & Osteopathic PhysiciansRadiologyRadiological Physics