Provider Demographics
NPI:1356489835
Name:SPRUILL, JOSEPH MILTON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MILTON
Last Name:SPRUILL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3361
Mailing Address - Country:US
Mailing Address - Phone:252-335-0503
Mailing Address - Fax:252-335-4015
Practice Address - Street 1:107 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3361
Practice Address - Country:US
Practice Address - Phone:252-335-0503
Practice Address - Fax:252-335-4015
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19404207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC897905OMedicaid
NC34DO242422OtherCLA
NCD33019OtherUPIN
NC897905OMedicaid