Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | MD26375 | OR |
NPI | 1467499475 |
---|---|
Provider Name | Dr. Kevin Wilson Parks |
First Address | Medford, OR 97504-9741 |
Second Address | Medford, OR 97504-9741 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 18/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
120824 | (02) | OR |