Provider Demographics
NPI:1114946209
Name:PARKS, FRANK LOWRY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:LOWRY
Last Name:PARKS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4262 DONCASTER DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-3754
Mailing Address - Country:US
Mailing Address - Phone:608-273-4641
Mailing Address - Fax:
Practice Address - Street 1:107 SE SWAN AVE.
Practice Address - Street 2:SILETZ COMMUNITY HEALTH CENTER
Practice Address - City:SILETZ
Practice Address - State:OR
Practice Address - Zip Code:97380-0320
Practice Address - Country:US
Practice Address - Phone:541-444-1030
Practice Address - Fax:541-444-9695
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI476-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIS71110Medicare UPIN