Provider Demographics
NPI:1891959755
Name:PARKS, LANCE J (DO)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:J
Last Name:PARKS
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1226 VAN VOORHIS RD
Mailing Address - Street 2:G3
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3426
Mailing Address - Country:US
Mailing Address - Phone:304-381-2068
Mailing Address - Fax:
Practice Address - Street 1:1 STADIUM DR
Practice Address - Street 2:RUBY MEMORIAL HOSPITAL DEPT OF ANESTHESIOLOGY
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505
Practice Address - Country:US
Practice Address - Phone:304-598-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV2350207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology