Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | 28547 | TX |
N | 1223G0001X | General Practice | 28547 | TX |
N | 213EG0000X | General Practice | 28547 | TX |
NPI | 1003042649 |
---|---|
Provider Name | Dr. Lucy H Park |
First Address | Katy, TX 77450-7150 |
Second Address | Katy, TX 77450-7150 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2009 |
Last Update Date | 03/02/2014 |