Basic Information
| Provider Information | |||||||||
| NPI: | 1023332756 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPARKUHL DELIA | ||||||||
| FirstName: | SCARLET | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 RIVERSIDE AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805244351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702241670 | ||||||||
| FaxNumber: | 9704956218 | ||||||||
| Practice Location | |||||||||
| Address1: | 3519 RICHMOND DR | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702040300 | ||||||||
| FaxNumber: | 9702269041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2010 | ||||||||
| LastUpdateDate: | 09/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | DR.0057041 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.