MEDICARE: ROBERT FRANKLIN SPARKS C.C.P.

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	242T00000X	Perfusionist	102	OK

General Provider Information

NPI Number	:	1861813743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT FRANKLIN SPARKS C.C.P.

Provider Business Mailing Address
First Line	:	3601 N MAY AVENUE
Second Line	:	SUITE C
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-6659
Country	:	US
Telephone Number	:	405-604-5613
Fax Number	:	405-601-0954

Provider Business Practice Location Address
First Line	:	3601 N MAY AVENUE
Second Line	:	SUITE C
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-6659
Country	:	US
Telephone Number	:	405-604-5613
Fax Number	:	405-601-0954

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

Provider Enumeration Date	:	12/19/2013
Last Update Date	:	12/19/2013

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