Jeffrey Ryan Sparks
Otolaryngology/Facial Plastic Surgery
515 E Grant St Suite 113
Macomb
, Illinois 61455-3368
Jeffrey Ryan Sparks
Otolaryngology/Facial Plastic Surgery
515 E Grant St Suite 113
Macomb
, Illinois 61455-3368
(309) 833-6937
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About
Features
Specialties
- Otolaryngology/Facial Plastic Surgery
Languages spoken
- English
Location
First Address
- Jeffrey Ryan Sparks
- 515 E Grant St Suite 113
- Macomb, IL
- Zip : 61455-3368
- Phone : (309) 833-6937
Second Address
- Jeffrey Ryan Sparks
- 515 E Grant St Suite 113
- Macomb, IL
- Zip : 61455-3368
- Phone : (309) 833-6937
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 036-132116 | IL |
| N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 2009026507 | MO |
National Provider Identifier
| NPI | 1780935197 |
|---|---|
| Provider Name | Jeffrey Ryan Sparks |
| First Address | Macomb, IL 61455-3368 |
| Second Address | Macomb, IL 61455-3368 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 25/09/2012 |
| Last Update Date | 28/02/2014 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.