Healthcare Provider Details

I. General information

NPI: 1720037070
Provider Name (Legal Business Name): ROY WALTER. SPRINKLE D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 GLENNS BAY RD
SURFSIDE BEACH SC
29575-4722
US

IV. Provider business mailing address

P.O.BOX 15908
SURFSIDE BEACH SC
29587-5908
US

V. Phone/Fax

Practice location:
  • Phone: 843-228-8989
  • Fax: 843-238-2787
Mailing address:
  • Phone: 843-238-8989
  • Fax: 843-238-2787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number99-0141
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: