MEDICARE: MR. WILLIAM J SPARROW AU.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	80346	TX

General Provider Information

NPI Number	:	1407164874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM J SPARROW AU.D.

Provider Business Mailing Address
First Line	:	4220 LITTLE ROCK CT
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-5759
Country	:	US
Telephone Number	:	435-881-3178
Fax Number	:

Provider Business Practice Location Address
First Line	:	2805 EARL RUDDER FWY S
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-6080
Country	:	US
Telephone Number	:	979-680-8808
Fax Number	:	979-696-7806

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2010
Last Update Date	:	09/20/2010

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