Individual
EDWARD MANNING SPROWL III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
318 ABALONE LOOP, MESCALERO, NM 88340
(575) 464-4441
Mailing address
318 ABALONE LOOP, MESCALERO, NM 88340
(575) 464-4441
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1016599
—
363AM0700X
Medical Physician Assistant
MA001481L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38553562
—
NM
05
—
846537
—
AZ
Enumeration date
07/07/2006
Last updated
02/11/2011
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