Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 4301078152 | MI |
N | 207PE0004X | Emergency Medical Services | 4301078152 | MI |
N | 207PP0204X | Pediatric Emergency Physician | 4301078152 | MI |
NPI | 1033136098 |
---|---|
Provider Name | Dr. Amy L. Sparkman |
First Address | Oklahoma City, OK 73104-5008 |
Second Address | Oklahoma City, OK 73104-5008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2006 |
Last Update Date | 16/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0B51090 | BLUE SHIELD (01) | MI |
4950313 | (05) | MI |
I24050 | (02) | MI |