Provider Demographics
NPI:1518045137
Name:PARKS, SAMUEL D (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:D
Last Name:PARKS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:401 W 2ND ST
Mailing Address - Street 2:226
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-5345
Mailing Address - Country:US
Mailing Address - Phone:775-784-1223
Mailing Address - Fax:775-327-2006
Practice Address - Street 1:1 MANVILLE MEDICAL SCIENCES BLDG MS 350
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89557-0001
Practice Address - Country:US
Practice Address - Phone:775-784-4068
Practice Address - Fax:775-784-1636
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-09-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV4495207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVWQBCL01Medicare ID - Type UnspecifiedMEDICARE NUMBER
NVA50699Medicare UPIN