Provider Demographics
NPI:1205336229
Name:PARKS, MARK JUSTIN (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:JUSTIN
Last Name:PARKS
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Gender:M
Credentials:DO
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Mailing Address - Street 1:5310 E 31ST ST FL 13
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-5018
Mailing Address - Country:US
Mailing Address - Phone:918-561-5701
Mailing Address - Fax:918-561-1173
Practice Address - Street 1:717 S HOUSTON AVE STE 200
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-9005
Practice Address - Country:US
Practice Address - Phone:918-586-4500
Practice Address - Fax:918-586-4528
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2023-02-10
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Provider Licenses
StateLicense IDTaxonomies
OK6719207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2G4594OtherMEDICARE
OK200855730AMedicaid