Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 6998 | NV |
Y | 2080P0214X | Pediatric Pulmonologist | 6998 | NV |
NPI | 1649258302 |
---|---|
Provider Name | David Paul Parks JR. |
First Address | Las Vegas, NV 89102-2325 |
Second Address | Las Vegas, NV 89109-2218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2006 |
Last Update Date | 17/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002018486 | (05) | NV |
A03356 | (02) | NV |
BP0500048 | DEA (01) | NV |
CS07235 | STATE PHARMACY (01) | NV |