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General NPI Number Information
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NPI Number | 1841560992
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Entity Type | Organization
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Legal Business Name | JEROME O SPRUILL MD PA
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Dates
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Enumeration Date | 01/06/2012
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Last Update Date | 01/06/2012
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Provider Practice Location Address
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Address Line | 1307 N ELM ST
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City | GREENSBORO
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State | NC
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Zip | 27401-6307
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Country | US
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Telephone | 336-273-6911
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Fax | 336-273-9999
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Provider Business Mailing Address
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Address Line | 1307 N ELM ST
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City | GREENSBORO
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State | NC
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Zip | 27401-6307
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Country | US
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Telephone | 336-273-6911
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Fax | 336-273-9999
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEROME O SPRUILL
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Credential | MD
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Telephone | 336-273-6911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 28092
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License Number State | NC
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