Provider Demographics
NPI:1699754945
Name:SPROUSE, ROBERT J (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:SPROUSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:JOHNSON
Other - Last Name:SPROUSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1800 GRANVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-1043
Mailing Address - Country:US
Mailing Address - Phone:740-785-4678
Mailing Address - Fax:740-687-1518
Practice Address - Street 1:1800 GRANVILLE PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1043
Practice Address - Country:US
Practice Address - Phone:740-785-4678
Practice Address - Fax:740-687-1518
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-14
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046012S207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0460808Medicaid
OH0460808Medicaid
CIGNAOther12376
ANTHEMOther000000008961
UNITED HEALTHCAREOther0101342
SP0495141Medicare ID - Type Unspecified
A80004Medicare UPIN