Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 2017020617 | MO |
N | 111NI0900X | Internist | 2017020617 | MO |
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 2019012322 | MO |
NPI | 1184157323 |
---|---|
Provider Name | Dr. Arick Charles Park |
First Address | St. Louis, MO 63110 |
Second Address | Saint Louis, MO 63110-1003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2017 |
Last Update Date | 11/11/2021 |