Provider Demographics
NPI:1861468738
Name:SPARKMAN, SUSAN K (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:K
Last Name:SPARKMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:SPARKMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3400 BISSONNET STREET, SUITE 298
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005
Mailing Address - Country:US
Mailing Address - Phone:713-667-8775
Mailing Address - Fax:713-667-4321
Practice Address - Street 1:3400 BISSONNET STREET, SUITE 298
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005
Practice Address - Country:US
Practice Address - Phone:713-667-8775
Practice Address - Fax:713-667-4321
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE46952084P0800X, 208000000X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
00QE08Medicare ID - Type Unspecified
E36580Medicare UPIN