Healthcare Provider Details

I. General information

NPI: 1215226667
Provider Name (Legal Business Name): JAMIE RAE SPARROW D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 E FLOWER ST
PHOENIX AZ
85014-5698
US

IV. Provider business mailing address

1510 E FLOWER ST
PHOENIX AZ
85014-5698
US

V. Phone/Fax

Practice location:
  • Phone: 602-530-6900
  • Fax:
Mailing address:
  • Phone: 602-530-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A12797
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO2001
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number007530
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: