Provider Demographics
NPI:1659417731
Name:PARKS, TARA T (DPM)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:T
Last Name:PARKS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:MS
Other - First Name:TARA
Other - Middle Name:TERESE
Other - Last Name:TORMEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2750 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3573
Mailing Address - Country:US
Mailing Address - Phone:303-440-3036
Mailing Address - Fax:303-440-3232
Practice Address - Street 1:2750 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3573
Practice Address - Country:US
Practice Address - Phone:303-440-3036
Practice Address - Fax:303-440-3232
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPOD-667213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO808794Medicare PIN