Provider Demographics
NPI:1649486085
Name:SPARKS, SCOTT ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALLEN
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:PSC 563
Mailing Address - Street 2:BOX 7013
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96388
Mailing Address - Country:JP
Mailing Address - Phone:8198-926-4551
Mailing Address - Fax:
Practice Address - Street 1:PSC 563
Practice Address - Street 2:BOX 7013
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96388
Practice Address - Country:JP
Practice Address - Phone:8198-926-4551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057581A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology