Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | R3221 | TX |
NPI | 1003235193 |
---|---|
Provider Name | Jordan Daniel Sparkman |
First Address | Houston, TX 77030 |
Second Address | Houston, TX 77030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2014 |
Last Update Date | 29/07/2021 |