Provider Demographics
NPI:1073568564
Name:SPARKS, TWANA LIVETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:TWANA
Middle Name:LIVETTE
Last Name:SPARKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-5516
Mailing Address - Country:US
Mailing Address - Phone:505-538-0486
Mailing Address - Fax:505-538-9179
Practice Address - Street 1:1000 N HUDSON ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-5516
Practice Address - Country:US
Practice Address - Phone:505-538-0486
Practice Address - Fax:505-538-9179
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM87-386NM207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM002363OtherBC/BS OF NM
NM3033OtherLOVELACE SALUD
NM3297479OtherCIGNA
NM3297479OtherCIGNA