Provider Demographics
NPI:1659348951
Name:SPRADLIN, DONALD BRUCE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:BRUCE
Last Name:SPRADLIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33270 US HIGHWAY 264
Mailing Address - Street 2:
Mailing Address - City:ENGELHARD
Mailing Address - State:NC
Mailing Address - Zip Code:27824-0277
Mailing Address - Country:US
Mailing Address - Phone:252-925-7000
Mailing Address - Fax:252-925-7700
Practice Address - Street 1:33270 US HWY 264
Practice Address - Street 2:BOX 277
Practice Address - City:ENGELHARD
Practice Address - State:NC
Practice Address - Zip Code:27824
Practice Address - Country:US
Practice Address - Phone:252-925-7000
Practice Address - Fax:252-925-7700
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04058363A00000X
TNPA000503363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1659348951Medicaid