MEDICARE: DR. THOMAS WAYNE SPARKS MD

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	174400000X	Specialist

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

General Provider Information

NPI Number	:	1972500627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS WAYNE SPARKS MD

Provider Business Mailing Address
First Line	:	19411 W PINEY POINT AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70817-2738
Country	:	US
Telephone Number	:	225-756-1340
Fax Number	:

Provider Business Practice Location Address
First Line	:	LSU UNIT
Second Line	:	5825 AIRLINE HIGHWAY
City	:	BATON ROUGE
State	:	LA
Zip	:	70805
Country	:	US
Telephone Number	:	225-358-1179
Fax Number	:

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	06/17/2008

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