Provider Demographics
NPI:1689650541
Name:PARK, DAVID I (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:I
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 35629
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-0629
Mailing Address - Country:US
Mailing Address - Phone:214-424-2213
Mailing Address - Fax:214-231-2159
Practice Address - Street 1:3032 COMMUNICATIONS PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8913
Practice Address - Country:US
Practice Address - Phone:972-943-8440
Practice Address - Fax:972-618-3623
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2977207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A2957OtherBCBS
TX151361601Medicaid
TX151361601Medicaid
TX100016959Medicare PIN
TXH53760Medicare UPIN