Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 2008011789 | MO |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 5279 | OK |
NPI | 1306082631 |
---|---|
Provider Name | Jason Robert Sparks |
First Address | Tulsa, OK 74133-4668 |
Second Address | Tulsa, OK 74133-4668 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2008 |
Last Update Date | 09/09/2020 |