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General NPI Number Information
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NPI Number | 1295239747
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Entity Type | Individual
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Provider Name | CHANDLER WAYNE SPARKS DO, MPH, MS
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Gender | Male
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Dates
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Enumeration Date | 03/20/2018
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Last Update Date | 08/13/2024
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Provider Practice Location Address
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Address Line | 133 BENMORE DR STE 200
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City | WINTER PARK
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State | FL
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Zip | 32792-4111
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Country | US
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Telephone | 407-646-7070
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Fax | 407-646-7747
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Provider Business Mailing Address
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Address Line | 531 WESTBURY DR
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City | GRAPEVINE
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State | TX
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Zip | 76051-4463
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Country | US
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Telephone | 817-773-7753
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Fax |
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 2021042303
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS21057
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License Number State | FL
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