Provider Demographics
NPI:1164579843
Name:PARKS, JONATHAN ROLAND (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ROLAND
Last Name:PARKS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5005 N PIEDRAS ST
Mailing Address - Street 2:WBAMC
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920-5001
Mailing Address - Country:US
Mailing Address - Phone:915-569-1386
Mailing Address - Fax:915-569-1233
Practice Address - Street 1:MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-5001
Practice Address - Country:US
Practice Address - Phone:253-968-1460
Practice Address - Fax:253-968-0448
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2019-04-24
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Provider Licenses
StateLicense IDTaxonomies
TN038912207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism