Provider Demographics
NPI:1265536254
Name:SPARKS, VICKI J (MD)
Entity type:Individual
Prefix:DR
First Name:VICKI
Middle Name:J
Last Name:SPARKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:114 SOUTHBRIDGE ST STE D
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6200
Mailing Address - Country:US
Mailing Address - Phone:210-340-2707
Mailing Address - Fax:210-340-2746
Practice Address - Street 1:114 SOUTHBRIDGE ST SUITE D
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6200
Practice Address - Country:US
Practice Address - Phone:210-340-2707
Practice Address - Fax:210-340-2746
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6215207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139217710Medicaid
TX139217710Medicaid
TX00816PMedicare ID - Type Unspecified