Provider Demographics
NPI:1154306827
Name:SPRINKLE, RONNIE VERNON (MD)
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:VERNON
Last Name:SPRINKLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2660 W COVELL BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-5645
Mailing Address - Country:US
Mailing Address - Phone:530-747-3000
Mailing Address - Fax:530-747-3086
Practice Address - Street 1:2660 W COVELL BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-5645
Practice Address - Country:US
Practice Address - Phone:530-747-3000
Practice Address - Fax:530-747-3080
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG031829207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G318290Medicare ID - Type Unspecified
CAA44883Medicare UPIN
00G318290Medicare PIN