Provider Demographics
NPI:1518346568
Name:PARKS, CLAYTON GERALD (MD)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:GERALD
Last Name:PARKS
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 1:2200 LAKE VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-5596
Mailing Address - Country:US
Mailing Address - Phone:217-529-9266
Mailing Address - Fax:217-529-9151
Practice Address - Street 1:2200 LAKE VICTORIA DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-5596
Practice Address - Country:US
Practice Address - Phone:217-529-9266
Practice Address - Fax:217-529-9151
Is Sole Proprietor?:No
Enumeration Date:2015-05-22
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036150659207R00000X, 2084P0800X
IL1250697302084P0800X
CAA1735142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine