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General NPI Number Information
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NPI Number | 1194980524
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Entity Type | Organization
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Legal Business Name | SPARROW MEDICAL GROUP
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Dates
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Enumeration Date | 07/24/2008
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Last Update Date | 08/20/2008
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Provider Practice Location Address
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Address Line | 3736 N MARKET ST
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City | SHREVEPORT
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State | LA
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Zip | 71107-3104
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Country | US
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Telephone | 318-934-0082
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Fax | 318-934-0087
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Provider Business Mailing Address
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Address Line | PO BOX 7276
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City | SHREVEPORT
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State | LA
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Zip | 71137-7276
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Country | US
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Telephone | 318-934-0082
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Fax | 318-934-0087
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MILDRED WARE SCOTT
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Credential | PHD
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Telephone | 318-934-0082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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