Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 1001 | AK |
NPI | 1003911330 |
---|---|
Provider Name | Colby Parks |
First Address | Anchorage, AK 99508-4619 |
Second Address | Anchorage, AK 99508-4619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1001 | (05) | AK |
C97201 | (02) | AK |