Provider Demographics
NPI:1962609925
Name:SPARKS, STEPHEN S (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:S
Last Name:SPARKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2575 FENTON PKWY
Mailing Address - Street 2:#318
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-6776
Mailing Address - Country:US
Mailing Address - Phone:304-276-8234
Mailing Address - Fax:
Practice Address - Street 1:7930 FROST ST
Practice Address - Street 2:STE 300
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2737
Practice Address - Country:US
Practice Address - Phone:858-279-8763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22525208800000X
CAA103568208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology