Organization
SPARKS CLINIC P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN ROBERT SPARKS D.O. (PHYSICIAN)
(660) 665-1400
Entity
Organization
Contact information
Practice address
1410 CROWN DR, KIRKSVILLE, MO 63501-2548
(660) 665-1400
(660) 665-2081
Mailing address
1410 CROWN DR, PO BOX 703, KIRKSVILLE, MO 63501-2548
(660) 665-1400
(660) 665-2081
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R5954
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DG0675
PALMETTO GBA
MO
Enumeration date
10/03/2007
Last updated
11/16/2007
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