Healthcare Provider Details

I. General information

NPI: 1952312217
Provider Name (Legal Business Name): DEAN SPARKS P.A.-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16760 N HIGHWAY 41
RATHDRUM ID
83858-8715
US

IV. Provider business mailing address

14402 E SPRAGUE AVE
SPOKANE VALLEY WA
99216-2167
US

V. Phone/Fax

Practice location:
  • Phone: 208-687-5627
  • Fax: 844-807-3782
Mailing address:
  • Phone: 509-922-2625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA16890
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA60599094
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-2073
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: