Provider Demographics
NPI:1598751653
Name:PARKS, ALAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:J
Last Name:PARKS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:150 TAYLOR STATION RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-4440
Mailing Address - Country:US
Mailing Address - Phone:614-863-3222
Mailing Address - Fax:614-863-4450
Practice Address - Street 1:150 TAYLOR STATION RD
Practice Address - Street 2:SUITE 250
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-4440
Practice Address - Country:US
Practice Address - Phone:614-863-3222
Practice Address - Fax:614-863-4450
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2011-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35054686P207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0665856Medicaid
OH9263901Medicare ID - Type Unspecified
OH0665856Medicaid