Healthcare Provider Details

I. General information

NPI: 1376837872
Provider Name (Legal Business Name): ERIC SPARKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 7TH AVE. SOUTH LOWDER SUITE 300
BIRMINGHAM AL
35233
US

IV. Provider business mailing address

555 UNIVERSITY AVENUE ROY HILL WING, 1526
TORONTO ON
M5G 1X8
CA

V. Phone/Fax

Practice location:
  • Phone: 205-638-9688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number43082
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301115111
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberBP10041441
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: