Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DS0000003754 | TN |
NPI | 1174680326 |
---|---|
Provider Name | Dr. Larman Wayne Sprouse |
First Address | Knoxville, TN 37950-9019 |
Second Address | Knoxville, TN 37920-2205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 08/07/2007 |