| Doctor Name: | DR. DALE BOYD SPARKS |
| NPI Number: | 1194051581 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | C21850 |
| Business Practice Address: | 29368 Big Range Rd Canyon Lake, CA - 925877652 |
| Business Phone Number: | 9512447311 |
| Business Fax Number: | 9512447311 |
| Mailing Address: | 29368 Big Range Rd, CANYON LAKE |
| State: | CA |
| Postal Code: | 925877652 |
| Phone Number: | 9512447311 |
| Fax Number: | 9512447311 |
| NPI Enumeration Date: | 10/20/2009 |
| NPI Last Update Date: | 10/20/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207KA0200X |
| License Number: | C21850 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Allergy & Immunology |
| Taxonomy Specialization: | Allergy |
| Taxonomy Definition: | |