Provider Demographics
NPI:1003898495
Name:PARKS, JOSEPH J (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:J
Last Name:PARKS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:FAMILY HEALTH CENTER OF BOONE COUNTY
Mailing Address - Street 2:1001 WEST WORLEY
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:35203-2037
Mailing Address - Country:US
Mailing Address - Phone:573-214-2314
Mailing Address - Fax:573-814-2784
Practice Address - Street 1:FAMILY HEALTH CENTER OF BOONE COUNTY
Practice Address - Street 2:1001 WEST WORLEY
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:35203-2037
Practice Address - Country:US
Practice Address - Phone:573-214-2314
Practice Address - Fax:573-814-2784
Is Sole Proprietor?:No
Enumeration Date:2005-11-19
Last Update Date:2022-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO1028042084P0800X
TN64665208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO206741324Medicaid
MO1003898495OtherNPI NUMBER