Provider Demographics
NPI:1558711986
Name:SPROUSE, BRETT R (DO, MBA)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:R
Last Name:SPROUSE
Suffix:
Gender:M
Credentials:DO, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 SOUTH DONAHUE DR SUITE 200
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36849-4256
Mailing Address - Country:US
Mailing Address - Phone:334-844-9919
Mailing Address - Fax:
Practice Address - Street 1:349 SOUTH DONAHUE DR SUITE 200
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36849-4256
Practice Address - Country:US
Practice Address - Phone:334-844-9919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.2012207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine