Healthcare Provider Details

I. General information

NPI: 1861813743
Provider Name (Legal Business Name): ROBERT FRANKLIN SPARKS C.C.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2013
Last Update Date: 12/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 N MAY AVENUE SUITE C
OKLAHOMA CITY OK
73112-6659
US

IV. Provider business mailing address

3601 N MAY AVENUE SUITE C
OKLAHOMA CITY OK
73112-6659
US

V. Phone/Fax

Practice location:
  • Phone: 405-604-5613
  • Fax: 405-601-0954
Mailing address:
  • Phone: 405-604-5613
  • Fax: 405-601-0954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number102
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: