Provider Demographics
NPI:1912769795
Name:SPROUSE, CALEB (MD)
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:
Last Name:SPROUSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CALEB
Other - Middle Name:MICHAEL
Other - Last Name:SPROUSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1822 OAKCREST CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4564
Mailing Address - Country:US
Mailing Address - Phone:423-712-0558
Mailing Address - Fax:
Practice Address - Street 1:9300 DEWITT LOOP
Practice Address - Street 2:
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5285
Practice Address - Country:US
Practice Address - Phone:571-231-1803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider