Individual
JEFFREY RYAN SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
515 E GRANT ST, SUITE 113, MACOMB, IL 61455-3368
(309) 833-6937
Mailing address
515 E GRANT ST, SUITE 113, MACOMB, IL 61455-3368
(309) 833-6937
Taxonomy
Speciality
Code
Description
License number
State
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
036-132116
IL
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
2009026507
MO
Other
Enumeration date
09/25/2012
Last updated
02/28/2014
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