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General NPI Number Information
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NPI Number | 1891966446
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Entity Type | Individual
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Provider Name | PETER TIMOTHY SPROCKEL M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/21/2008
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Last Update Date | 08/08/2024
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Provider Practice Location Address
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Address Line | 18700 KATY FWY STE 603
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City | HOUSTON
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State | TX
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Zip | 77094-1421
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Country | US
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Telephone | 832-522-8280
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Fax | 832-522-8281
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Provider Business Mailing Address
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Address Line | 18700 KATY FWY STE 603
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City | HOUSTON
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State | TX
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Zip | 77094-1421
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Country | US
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Telephone | 832-522-8280
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Fax | 832-522-8281
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | N1460
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | N1460
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License Number State | TX
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