Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
JEFFREY RYAN SPARKS, D.O.
ActiveJEFFREY RYAN SPARKS, D.O. is a Facial Plastic Surgery healthcare provider located in MACOMB, Illinois. NPI 1780935197 is currently active in the NPPES registry. Verify at CMS.
Facial Plastic Surgery · MACOMB, IL
Registration Details
- NPI Number
- 1780935197
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Sep 25, 2012 (13.89552177817 yrs)
- Last Updated
- Feb 28, 2014
- Licenses
-
2009026507 (MO)036-132116 (IL)
Practice Information
- Address
-
515 E GRANT STSUITE 113MACOMB, IL, 614553368Browse IL providers · Browse ZIP 61455
- Phone
- 3098336937
- Primary Specialty
-
Facial Plastic Surgery
207YX0905X
- Additional Specialty
- Facial Plastic Surgery
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.