Provider Demographics
NPI:1407096027
Name:SPARKS, JASON PHILIP (MED, CPHT, PHTR)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:PHILIP
Last Name:SPARKS
Suffix:
Gender:M
Credentials:MED, CPHT, PHTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12409 ACE IN THE HOLE LN
Mailing Address - Street 2:
Mailing Address - City:DEL VALLE
Mailing Address - State:TX
Mailing Address - Zip Code:78617-2050
Mailing Address - Country:US
Mailing Address - Phone:512-983-1740
Mailing Address - Fax:
Practice Address - Street 1:12400 W HWY 71
Practice Address - Street 2:
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738-6517
Practice Address - Country:US
Practice Address - Phone:512-263-0561
Practice Address - Fax:512-263-7179
Is Sole Proprietor?:No
Enumeration Date:2009-02-22
Last Update Date:2025-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100125183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician