Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 14552 | NV |
N | 111NI0900X | Internist | 14552 | NV |
N | 207R00000X | Internist | MD30481 | TN |
N | 111NI0900X | Internist | MD30481 | TN |
N | 207RH0000X | Hematologist | 14552 | NV |
N | 207RH0003X | Hematology & Oncology | 14552 | NV |
N | 207RH0003X | Hematology & Oncology | MD30481 | TN |
Y | 207RH0003X | Hematology & Oncology | MD462646 | PA |
N | 207RX0202X | Medical Oncology | 14552 | NV |
NPI | 1285714352 |
---|---|
Provider Name | Dr. Don J Park |
First Address | Philadelphia, PA 19178-3311 |
Second Address | Allentown, PA 18103-6218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 29/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10838324 | CAQH (01) | |
1285714352 | (05) | NV |
G79963 | (02) | TN |