Provider Demographics
NPI:1710907498
Name:PARKS, RALPH A (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:A
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 1:1209 SNIDER ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4221
Mailing Address - Country:US
Mailing Address - Phone:276-783-9752
Mailing Address - Fax:276-783-7786
Practice Address - Street 1:1209 SNIDER ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-4221
Practice Address - Country:US
Practice Address - Phone:276-783-9752
Practice Address - Fax:276-783-7786
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235885207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010048281Medicaid
VA104318OtherANTHEM
00V922R01Medicare PIN
VA022014S97Medicare PIN
VA010048281Medicaid