Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | MD26333 | TN |
NPI | 1245208719 |
---|---|
Provider Name | John Sparrow |
First Address | Jackson, TN 38302-0400 |
Second Address | Jackson, TN 38301-3946 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2006 |
Last Update Date | 18/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3087930 | (05) | TN |
E20861 | (02) |