Provider Demographics
NPI:1043294861
Name:DEPANI-SPARKES, ELISA (DO)
Entity Type:Individual
Prefix:DR
First Name:ELISA
Middle Name:
Last Name:DEPANI-SPARKES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-657-3825
Mailing Address - Fax:405-657-3824
Practice Address - Street 1:4833 INTEGRIS PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-8864
Practice Address - Country:US
Practice Address - Phone:405-657-3825
Practice Address - Fax:405-657-3824
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2018-03-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK4254207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200077710AMedicaid
OK244631703Medicare PIN
OK200077710AMedicaid