Provider Demographics
NPI:1720037070
Name:SPRINKLE, ROY WALTER (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:WALTER
Last Name:SPRINKLE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O.BOX 15908
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29587-5908
Mailing Address - Country:US
Mailing Address - Phone:843-238-8989
Mailing Address - Fax:843-238-2787
Practice Address - Street 1:1103 GLENNS BAY RD
Practice Address - Street 2:
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-4722
Practice Address - Country:US
Practice Address - Phone:843-228-8989
Practice Address - Fax:843-238-2787
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC99-0141213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCU629600283Medicare UPIN