Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 0401005416 | VA |
Y | 213EG0000X | General Practice | 0401005416 | VA |
NPI | 1003010612 |
---|---|
Provider Name | Dr. Patrick Earle Sprague |
First Address | Luray, VA 22835-9734 |
Second Address | Luray, VA 22835-9734 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2007 |
Last Update Date | 08/07/2007 |