Provider Demographics
NPI:1407812936
Name:SPRUILL, JEROME OSCAR (MD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:OSCAR
Last Name:SPRUILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5102 DUNSTAN RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-9565
Mailing Address - Country:US
Mailing Address - Phone:336-375-6109
Mailing Address - Fax:336-375-6676
Practice Address - Street 1:1307 N ELM ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6307
Practice Address - Country:US
Practice Address - Phone:336-273-6911
Practice Address - Fax:336-273-9999
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-24
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28092207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC81724Medicare UPIN
203220Medicare ID - Type Unspecified