Provider Demographics
NPI:1578738621
Name:PARKS, JESSE PATRICK (DPM)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:PATRICK
Last Name:PARKS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3429
Mailing Address - Country:US
Mailing Address - Phone:203-874-6755
Mailing Address - Fax:203-877-7849
Practice Address - Street 1:32 CHERRY ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3429
Practice Address - Country:US
Practice Address - Phone:203-874-6755
Practice Address - Fax:203-877-7849
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000832213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist