Provider Demographics
NPI:1215985312
Name:SPARKS, ROBERT DALE (DO)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DALE
Last Name:SPARKS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 N FIRST ST
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-3033
Mailing Address - Country:US
Mailing Address - Phone:972-771-5366
Mailing Address - Fax:972-771-0424
Practice Address - Street 1:103 N FIRST ST
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-3033
Practice Address - Country:US
Practice Address - Phone:972-771-5366
Practice Address - Fax:972-771-0424
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0682207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1215985312Medicare Oscar/Certification
TX8K9708Medicare PIN