=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306051677
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADAM GRAYMOOR SPRANKELL M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2007
-----------------------------------------------------
Last Update Date | 06/17/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | RR 6 BOX 840 WILMA P. MANKILLER CLINIC, CHEROKEE NATION
-----------------------------------------------------
City | STILWELL
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74960-8703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-696-8800
-----------------------------------------------------
Fax | 918-696-3879
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | RR 6 BOX 840 WILMA P. MANKILLER CLINIC, CHEROKEE NATION
-----------------------------------------------------
City | STILWELL
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74960-8703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-696-8800
-----------------------------------------------------
Fax | 918-696-3879
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | E5608
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 30952
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------