Provider Demographics
NPI:1457336588
Name:SPRUILL, STEVEN CARL (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:CARL
Last Name:SPRUILL
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:PO BOX 1257
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-1257
Mailing Address - Country:US
Mailing Address - Phone:252-823-6333
Mailing Address - Fax:252-823-1406
Practice Address - Street 1:1850 W ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5704
Practice Address - Country:US
Practice Address - Phone:252-413-6641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2003-01295207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE3049OtherMEDCOST
NC140UMOtherBLUE CROSS BLUE SHIELD
NC5900845Medicaid
NC2040914Medicare ID - Type Unspecified
NCE3049OtherMEDCOST