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General NPI Number Information
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NPI Number | 1649377722
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Entity Type | Organization
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Legal Business Name | JACK T. SPROUL, MD PC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 11/06/2009
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Provider Practice Location Address
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Address Line | 135 N MAIN ST
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City | CORTLAND
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State | NY
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Zip | 13045-1226
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Country | US
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Telephone | 607-756-6330
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Fax |
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Provider Business Mailing Address
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Address Line | 135 N MAIN ST
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City | CORTLAND
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State | NY
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Zip | 13045-1226
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Country | US
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Telephone | 607-756-6330
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JACK T SPROUL
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Credential | MD
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Telephone | 607-756-6330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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