Individual
DR. JACK T SPROUL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
101 DOCTORS PARK, GALAX, VA 24333-2277
(276) 238-0990
(276) 238-1081
Mailing address
101 DOCTORS PARK, GALAX, VA 24333-2277
(276) 238-0990
(276) 238-1081
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
0101254866
VA
207X00000X
Orthopaedic Surgery Physician
185796
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01243865
—
NY
Enumeration date
01/19/2006
Last updated
09/29/2015
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