Organization
DR. DAVID M. SPARKS, M.D., PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID MICHAEL SPARKS M.D. (PHYSICIAN)
(580) 762-0202
Entity
Organization
Contact information
Practice address
415 FAIRVIEW AVE, SUITE 201, PONCA CITY, OK 74601-1923
(580) 762-0202
Mailing address
415 FAIRVIEW AVE, SUITE 201, PONCA CITY, OK 74601-1923
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
22621
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200060140B
—
OK
Enumeration date
09/02/2006
Last updated
01/07/2010
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