Individual
DR. RANDAL P SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
600 EAST FAIRVIEW AVENUE, OLIVIA, MN 56277-1399
(320) 523-1460
Mailing address
600 E PARK AVE, OLIVIA, MN 56277-1370
(320) 523-1460
(320) 523-1703
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
52538
MN
207Q00000X
Family Medicine Physician
DO-437
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004119242
AETNA
—
01
—
0110005
UNITED HEALTHCARE
—
01
—
51028285
BLUE CROSS BLUE SHIELD
AL
05
—
529402090
—
AL
01
—
6309683290010
CIGNA
—
Enumeration date
08/31/2006
Last updated
06/05/2015
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