Healthcare Provider Details

I. General information

NPI: 1043288822
Provider Name (Legal Business Name): RHONDA A SPARKS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 SW 59TH ST
OKLAHOMA CITY OK
73119-7025
US

IV. Provider business mailing address

PO BOX 740020
ATLANTA GA
30374-0020
US

V. Phone/Fax

Practice location:
  • Phone: 403-303-7555
  • Fax: 405-561-5615
Mailing address:
  • Phone: 312-733-9730
  • Fax: 773-866-8014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01075874A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19503
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: