Individual
DR. ROBERT W SPARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2200 S HALLIBURTON ST, KIRKSVILLE, MO 63501-4651
(660) 627-1560
(660) 665-0533
Mailing address
PO BOX 1085, 2200 S HALLIBURTON, KIRKSVILLE, MO 63501-1085
(660) 627-1560
(660) 665-0533
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R9D41
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010047006
RAILROAD MEDICARE
MO
01
—
136077
HEALTHLINK
MO
05
—
242000339
—
MO
01
—
25936
BLUE CROSS BLUE SHIELD
MO
01
—
4419174
AETNA
MO
Enumeration date
09/20/2006
Last updated
08/16/2010
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