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General NPI Number Information
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NPI Number | 1831630565
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Entity Type | Organization
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Legal Business Name | FAMILY PRACTICE ASSOCIATES OF KERRVILLE, PLLC
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Dates
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Enumeration Date | 03/14/2017
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Last Update Date | 03/21/2017
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Provider Practice Location Address
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Address Line | 220 WESLEY DR
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City | KERRVILLE
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State | TX
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Zip | 78028-5809
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Country | US
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Telephone | 830-896-4711
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Fax | 830-257-0878
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Provider Business Mailing Address
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Address Line | 220 WESLEY DR
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City | KERRVILLE
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State | TX
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Zip | 78028-5809
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Country | US
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Telephone | 830-896-4711
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Fax | 830-257-0878
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Authorized Official
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Title or Position | PROVIDER/ OWNER
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Name | DAVID R SPROUSE
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Credential | MD
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Telephone | 830-896-4711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | H2802
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License Number State | TX
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