Individual
PATRICK G. SPORLEDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3527 W TRUMAN BLVD, JEFFERSON CITY, MO 65109-5715
(573) 761-7979
(573) 761-5515
Mailing address
PO BOX 1027, JEFFERSON CITY, MO 65102-1027
(573) 681-3767
(573) 761-6947
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R4N43
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
243057858
—
MO
Enumeration date
11/02/2005
Last updated
10/07/2015
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