Provider Demographics
NPI:1821274234
Name:SPARKS, STEPHEN KOJI (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:KOJI
Last Name:SPARKS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:34 SW 89TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-8510
Mailing Address - Country:US
Mailing Address - Phone:405-488-0750
Mailing Address - Fax:405-488-0761
Practice Address - Street 1:34 SW 89TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-8510
Practice Address - Country:US
Practice Address - Phone:405-488-0750
Practice Address - Fax:405-488-0761
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK4559207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200194380AMedicaid
OKOK404770Medicare PIN