Provider Demographics
NPI:1689967192
Name:SPROUSE, RYAN ANDERSON (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:ANDERSON
Last Name:SPROUSE
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 1:203 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:RANSON
Mailing Address - State:WV
Mailing Address - Zip Code:25438-1617
Mailing Address - Country:US
Mailing Address - Phone:304-725-6343
Mailing Address - Fax:
Practice Address - Street 1:203 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:RANSON
Practice Address - State:WV
Practice Address - Zip Code:25438-1617
Practice Address - Country:US
Practice Address - Phone:304-725-6343
Practice Address - Fax:304-725-5523
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV26398207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine