Provider Demographics
NPI:1568465771
Name:SPRUILL, RONALD RAY JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:RAY
Last Name:SPRUILL
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:220 CAMPUS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2896
Mailing Address - Country:US
Mailing Address - Phone:540-536-5100
Mailing Address - Fax:540-536-0235
Practice Address - Street 1:100 OAK LEE DRIVE
Practice Address - Street 2:
Practice Address - City:RANSON
Practice Address - State:WV
Practice Address - Zip Code:25438
Practice Address - Country:US
Practice Address - Phone:304-930-0001
Practice Address - Fax:681-252-1843
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2021-03-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDC0002450363A00000X
VA0110007496363A00000X
WV2256363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2256OtherSTATE LICENSE
410LC819Medicare PIN
P48225Medicare UPIN