Provider Demographics
NPI:1467430959
Name:PARK, HARRY H (MD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:H
Last Name:PARK
Suffix:
Gender:M
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:PO BOX 1648
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-1648
Mailing Address - Country:US
Mailing Address - Phone:541-687-4900
Mailing Address - Fax:541-242-4364
Practice Address - Street 1:1007 HARLOW RD
Practice Address - Street 2:STE 210
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-7124
Practice Address - Country:US
Practice Address - Phone:541-284-1600
Practice Address - Fax:541-242-4634
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24583207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227319Medicaid
OR227319Medicaid
H86768Medicare UPIN