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Individual

BRIAN KEITH SPARKS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
9155 SW BARNES RD STE 333, PORTLAND, OR 97225-6630
(503) 216-5102
(971) 282-0091
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494

Taxonomy

Speciality
Code
Description
License number
State
2084P0015X
Psychosomatic Medicine Physician
A142587
CA
2084P0800X
Psychiatry Physician
A142587
CA
2084P0800X
Psychiatry Physician
Primary
MD190671
OR

Other

Enumeration date
04/06/2012
Last updated
05/10/2023
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