Provider Demographics
NPI:1972609279
Name:SPARKS, JOHN ROBERT (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
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:PO BOX 703
Mailing Address - Street 2:1410 CROWN DRIVE
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-0703
Mailing Address - Country:US
Mailing Address - Phone:660-665-1400
Mailing Address - Fax:660-665-2081
Practice Address - Street 1:1410 CROWN DRIVE
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-0703
Practice Address - Country:US
Practice Address - Phone:660-665-1400
Practice Address - Fax:660-665-2081
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5954207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO273051OtherHEALTHLINK
MO11404039OtherBLUE CROSS BLUE SHIELD
D41749Medicare UPIN
MO11404039OtherBLUE CROSS BLUE SHIELD