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General NPI Number Information
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NPI Number | 1134259781
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Entity Type | Individual
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Provider Name | ROBERT T SPARROW MD
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Gender | Male
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 420 NE GLEN OAK AVE STE 401
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City | PEORIA
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State | IL
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Zip | 61603-3112
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Country | US
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Telephone | 309-676-8123
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Fax | 309-676-8455
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Provider Business Mailing Address
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Address Line | 420 NE GLEN OAK AVE STE 401
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City | PEORIA
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State | IL
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Zip | 61603-3112
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Country | US
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Telephone | 309-676-8123
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Fax | 309-676-8455
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0005X
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Taxonomy Name | Hypertension Specialist Physician
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License Number | 036062055
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 036062055
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License Number State | IL
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