Provider Demographics
NPI:1306082631
Name:SPARKS, JASON ROBERT (DO)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ROBERT
Last Name:SPARKS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8165 S MINGO RD STE 201
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4668
Mailing Address - Country:US
Mailing Address - Phone:918-286-3124
Mailing Address - Fax:918-286-3764
Practice Address - Street 1:8165 S MINGO RD STE 201
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4668
Practice Address - Country:US
Practice Address - Phone:918-286-3124
Practice Address - Fax:918-286-3764
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008011789207X00000X
OK5279207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery