| Doctor Name: | EDWARD MANNING SPROWL |
| NPI Number: | 1588696520 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PAC |
| License Number: | MA001481L |
| Business Practice Address: | 318 Abalone Loop Mescalero, NM - 88340 |
| Business Phone Number: | 5754644441 |
| Business Fax Number: | |
| Mailing Address: | 318 Abalone Loop, MESCALERO |
| State: | NM |
| Postal Code: | 88340 |
| Phone Number: | 5754644441 |
| Fax Number: | |
| NPI Enumeration Date: | 07/07/2006 |
| NPI Last Update Date: | 02/11/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | MA001481L |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |