Provider Demographics
NPI:1659512937
Name:SPROLES, ELIJAH THOMAS III (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIJAH
Middle Name:THOMAS
Last Name:SPROLES
Suffix:III
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 1:1124 CITY PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-3713
Mailing Address - Country:US
Mailing Address - Phone:504-237-6172
Mailing Address - Fax:
Practice Address - Street 1:1124 CITY PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-3713
Practice Address - Country:US
Practice Address - Phone:504-237-6172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.03537R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics