Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 10404 | NH |
NPI | 1023044930 |
---|---|
Provider Name | Dr. Michael B Sparks |
First Address | Lebanon, NH 03756-1000 |
Second Address | Lebanon, NH 03756-1000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 13/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0RE4900 | (05) | VT |
30011628 | (05) | NH |
G06742 | (02) |