Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PY6263 | FL |
Y | 103T00000X | Psychologist | PY6263 | FL |
NPI | 1003967316 |
---|---|
Provider Name | Dr. Timothy Eugene Spruill |
First Address | Orlando, FL 32828-8637 |
Second Address | Orlando, FL 32822-8204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2007 |
Last Update Date | 25/02/2013 |