Healthcare Provider Details

I. General information

NPI: 1699754945
Provider Name (Legal Business Name): ROBERT J SPROUSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ROBERT JOHNSON SPROUSE MD

II. Dates (important events)

Enumeration Date: 01/14/2006
Last Update Date: 02/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 GRANVILLE PIKE
LANCASTER OH
43130-1043
US

IV. Provider business mailing address

1800 GRANVILLE PIKE
LANCASTER OH
43130-1043
US

V. Phone/Fax

Practice location:
  • Phone: 740-785-4678
  • Fax: 740-687-1518
Mailing address:
  • Phone: 740-785-4678
  • Fax: 740-687-1518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35046012S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: