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General NPI Number Information
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NPI Number | 1255481883
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Entity Type | Individual
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Provider Name | JIMMY W. SPRUILL M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 04/28/2014
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Provider Practice Location Address
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Address Line | 1275 MARVIN HANCOCK DR
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City | JASPER
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State | TX
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Zip | 75951-4935
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Country | US
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Telephone | 409-384-1951
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Fax | 409-924-9696
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Provider Business Mailing Address
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Address Line | 3560 DELAWARE ST SUITE 601-A
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City | BEAUMONT
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State | TX
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Zip | 77706-3067
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Country | US
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Telephone | 800-258-2016
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Fax | 409-924-9696
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | F2033
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | F2033
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License Number State | TX
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