Provider Demographics
NPI:1972500627
Name:SPARKS, THOMAS WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WAYNE
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 1:19411 W PINEY POINT AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-2738
Mailing Address - Country:US
Mailing Address - Phone:225-756-1340
Mailing Address - Fax:
Practice Address - Street 1:LSU UNIT
Practice Address - Street 2:5825 AIRLINE HIGHWAY
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805
Practice Address - Country:US
Practice Address - Phone:225-358-1179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1184403Medicaid
LA1184403Medicaid
LA5K576Medicare PIN