Provider Demographics
NPI:1346350261
Name:SPARKS, DIERICK R (MD)
Entity Type:Individual
Prefix:
First Name:DIERICK
Middle Name:R
Last Name:SPARKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3102 RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:RAINBOW CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35906-5804
Mailing Address - Country:US
Mailing Address - Phone:256-546-8127
Mailing Address - Fax:256-666-4690
Practice Address - Street 1:3102 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:RAINBOW CITY
Practice Address - State:AL
Practice Address - Zip Code:35906-5804
Practice Address - Country:US
Practice Address - Phone:256-546-8127
Practice Address - Fax:256-547-6720
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-07-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL24950207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine