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General NPI Number Information
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NPI Number | 1447403753
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Entity Type | Organization
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Legal Business Name | LISA SPARKS, MD, PC
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Dates
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Enumeration Date | 10/30/2008
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Last Update Date | 10/30/2008
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Provider Practice Location Address
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Address Line | 14001 N 7TH ST B-104
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City | PHOENIX
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State | AZ
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Zip | 85022-4382
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Country | US
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Telephone | 602-993-2959
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Fax |
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Provider Business Mailing Address
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Address Line | 14001 N 7TH ST B-104
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City | PHOENIX
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State | AZ
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Zip | 85022-4382
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Country | US
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Telephone | 602-993-2959
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LISA SPARKS
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Credential | MD
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Telephone | 602-993-2959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 13545
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License Number State | AZ
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