Provider Demographics
NPI:1487664744
Name:PARKS MYTON, ALEXIS D (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:D
Last Name:PARKS MYTON
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 1:235 W NATIONAL RD.
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-1969
Mailing Address - Country:US
Mailing Address - Phone:937-898-3600
Mailing Address - Fax:937-898-2731
Practice Address - Street 1:235 W NATIONAL RD.
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-9725
Practice Address - Country:US
Practice Address - Phone:937-898-3600
Practice Address - Fax:937-898-2731
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067512207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35067512OtherOHIO MEDICAL LICENSE
OH0989793Medicaid
OH35067512OtherOHIO MEDICAL LICENSE
OHBM4178047OtherDEA NUMBER
OH0989793Medicaid