Provider Demographics
NPI:1619252525
Name:PARKS, CHRISTOPHER READE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:READE
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 1:9450 MING AVE.
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311
Mailing Address - Country:US
Mailing Address - Phone:661-847-9930
Mailing Address - Fax:661-847-9932
Practice Address - Street 1:9450 MING AVE.
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311
Practice Address - Country:US
Practice Address - Phone:661-847-9930
Practice Address - Fax:661-847-9932
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42233208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA48871Medicare UPIN