Provider Demographics
NPI:1831131986
Name:SPARKS, VICTOR LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:LEE
Last Name:SPARKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 AL HIGHWAY 69
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-7140
Mailing Address - Country:US
Mailing Address - Phone:256-753-8000
Mailing Address - Fax:
Practice Address - Street 1:8000 AL HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-7140
Practice Address - Country:US
Practice Address - Phone:256-753-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00019418207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009986245Medicaid
AL51526381SPAOtherBLUE SHIELD
ALP00101956OtherRAILROAD MEDICARE
G15989Medicare UPIN
ALP00101956OtherRAILROAD MEDICARE