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General NPI Number Information
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NPI Number | 1215124276
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Entity Type | Organization
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Legal Business Name | SPARKS CLINIC P.C.
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Dates
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Enumeration Date | 10/03/2007
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Last Update Date | 11/16/2007
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Provider Practice Location Address
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Address Line | 1410 CROWN DR
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City | KIRKSVILLE
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State | MO
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Zip | 63501-2548
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Country | US
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Telephone | 660-665-1400
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Fax | 660-665-2081
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Provider Business Mailing Address
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Address Line | 1410 CROWN DR PO BOX 703
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City | KIRKSVILLE
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State | MO
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Zip | 63501-2548
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Country | US
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Telephone | 660-665-1400
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Fax | 660-665-2081
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JOHN ROBERT SPARKS
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Credential | D.O.
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Telephone | 660-665-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R5954
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License Number State | MO
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