Provider Demographics
NPI:1134108723
Name:PARKS, JENNY L (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:L
Last Name:PARKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-5049
Mailing Address - Country:US
Mailing Address - Phone:513-533-6100
Mailing Address - Fax:513-533-6105
Practice Address - Street 1:905 MAIN ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-5049
Practice Address - Country:US
Practice Address - Phone:513-533-6100
Practice Address - Fax:513-533-6105
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-070294208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0273243Medicaid