MEDICARE: DR. VICTOR LEE SPARKS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	00019418	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00101956	OTHER	AL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	51526381SPA	OTHER	AL	BLUE SHIELD

General Provider Information

NPI Number	:	1831131986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTOR LEE SPARKS M.D.

Provider Business Mailing Address
First Line	:	8000 AL HIGHWAY 69
Second Line	:
City	:	GUNTERSVILLE
State	:	AL
Zip	:	35976-7140
Country	:	US
Telephone Number	:	256-753-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	8000 AL HIGHWAY 69
Second Line	:
City	:	GUNTERSVILLE
State	:	AL
Zip	:	35976-7140
Country	:	US
Telephone Number	:	256-753-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	06/11/2012

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