Provider Demographics
NPI:1558564591
Name:PARKS, JOSEPH WILLIAM IV (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WILLIAM
Last Name:PARKS
Suffix:IV
Gender:M
Credentials:MD
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Mailing Address - Street 1:11945 SAN JOSE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1627
Mailing Address - Country:US
Mailing Address - Phone:904-396-1725
Mailing Address - Fax:904-399-1717
Practice Address - Street 1:14540 OLD SAINT AUGUSTINE RD STE 2391
Practice Address - Street 2:SUITE C50
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-7418
Practice Address - Country:US
Practice Address - Phone:904-262-3372
Practice Address - Fax:904-262-3306
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2014-01-29
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Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME 116390208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program