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General NPI Number Information
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NPI Number | 1265487946
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Entity Type | Individual
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Provider Name | JUSTIN SCOTT SPARKES D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4509 INTEGRIS PKWY STE 200
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City | EDMOND
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State | OK
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Zip | 73034-8696
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Country | US
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Telephone | 405-657-3950
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Fax | 405-471-0040
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Provider Business Mailing Address
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Address Line | 5300 N INDEPENDENCE AVE SUITE 280
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-5556
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Country | US
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Telephone | 405-657-3950
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Fax | 405-471-0040
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4253
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License Number State | OK
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