Provider Demographics
NPI:1952682312
Name:JOHN C. SPARKS JR. MD
Entity Type:Organization
Organization Name:JOHN C. SPARKS JR. MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:936-539-2663
Mailing Address - Street 1:1020 RIVERWOOD CT
Mailing Address - Street 2:SUITE 340
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304
Mailing Address - Country:US
Mailing Address - Phone:936-539-2663
Mailing Address - Fax:936-539-2664
Practice Address - Street 1:1020 RIVERWOOD CT
Practice Address - Street 2:SUITE 340
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304
Practice Address - Country:US
Practice Address - Phone:936-539-2663
Practice Address - Fax:936-539-2664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-30
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7351207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096941201Medicaid
TXTXB142050Medicare PIN
E89815Medicare UPIN
TX1147640001Medicare NSC