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General NPI Number Information
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NPI Number | 1912003054
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Entity Type | Organization
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Legal Business Name | SPARKS FAMILY MEDICINE LTD
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 410 S RAMPART BLVD STE 390
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City | LAS VEGAS
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State | NV
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Zip | 89145-5749
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Country | US
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Telephone | 702-722-2200
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Fax | 702-722-2201
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Provider Business Mailing Address
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Address Line | 410 S RAMPART BLVD STE 390
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City | LAS VEGAS
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State | NV
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Zip | 89145-5749
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Country | US
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Telephone | 702-722-2200
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Fax | 702-722-2201
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | BRETT W SPARKS
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Credential |
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Telephone | 702-813-7701
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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 | P07-02616-B-102535
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License Number State | NV
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