Provider Demographics
NPI:1154492585
Name:SPARROW, KRISTEN TRACY (MD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:TRACY
Last Name:SPARROW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2641 GREENWICH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-3205
Mailing Address - Country:US
Mailing Address - Phone:415-567-8180
Mailing Address - Fax:
Practice Address - Street 1:2000 VAN NESS AVE STE 506
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-3017
Practice Address - Country:US
Practice Address - Phone:415-775-0117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49255207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G492550Medicare ID - Type Unspecified