Individual
MR. BRIAN WAYNE SPARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
407 GATOR CV, BOSSIER CITY, LA 71111-8219
(318) 208-2029
Mailing address
407 GATOR CV, BOSSIER CITY, LA 71111-8219
(318) 208-2029
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.200306
LA
Other
Enumeration date
09/11/2009
Last updated
09/29/2009
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