Healthcare Provider Details

I. General information

NPI: 1316990245
Provider Name (Legal Business Name): THOMAS R. SPRUILL, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 03/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 BROWNING PL SUITE 201
RALEIGH NC
27609-6508
US

IV. Provider business mailing address

3900 BROWNING PL SUITE 201
RALEIGH NC
27609-6508
US

V. Phone/Fax

Practice location:
  • Phone: 919-787-7125
  • Fax: 919-781-9952
Mailing address:
  • Phone: 919-787-7125
  • Fax: 919-781-9952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number29803
License Number StateNC

VIII. Authorized Official

Name: DR. THOMAS R. SPRUILL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 919-787-7125